Reviewing National Health Expenditures

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Average Annual Percent Change from the Previous Year

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Conclusion

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3 Steps to Take Before Buying Healthcare E-Signature Solutions

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More on Paperless Healthcare Records

[By Patrick McTosh]

The movement towards paperless healthcare is growing. Every year, more and more health professionals are beginning to implement EMRs and EHRs as a way to turn their file cabinets into data on a hard drive. While EHRs help the problems of storing paper, they do not create documents that can be legally, securely and efficiently shared with third parties and patients during day to day activities.

These issues can be addressed by implementing an electronic signature solution. These types of solutions allow professions to create documents for physician orders, prescriptions, patient admissions, consent forms and other important medical documents in a timely and relatively paper free manner.

Verify EHR or EMR Integration

It’s important to ensure that whatever electronic signature software is compatible with your current EHR and EMR software. While most e-signature solution providers claim they have specialized services for healthcare organization, it’s best to confirm with a phone call or email that they have experience integrating their services with the EMR that is currently in use.

Verify Local Legislation & Signature Guidelines

Hospital accreditors have already recognized e-signatures as equivalent to paper signatures. However, it’s always important to verify federal and state regulations regarding e-prescriptions and electronic signatures.

For example, the latest DEA regulations on electronic prescriptions require digital signatures to have at least a biometric authentication. In addition, some states have not adopted the Uniform Electronic Transactions Act and therefore have difference laws pertaining to the legality of e-signatures.

Most e-signature providers specializing in healthcare tend to be on top of these things because better legal compliance is one of the benefits of e-signatures as a whole, but it’s always better do double check.

eHRs

Ensure It’s Human Error Proof

Many e-signature solutions attempt to reduce the risk of human error due to lost, damage or incorrectly completed forms which can cause significant delays. As most e-signature software will actually guide the signer through the complete process ensuring that the document meets necessary requirements before sealing the document with a tamper-evident digital seal.

Assessment

However, not all providers have such precautions against human errors, but it is definitely a must in the healthcare industry.

Conclusion

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On Inheritances by Country

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Spending an Inheritance

By Rick Kahler CFP® www.KahlerFinancial.comRick Kahler CFP

Stroll through a retirement camping resort or pass an RV on the highway, and you might see this bumper sticker:

“We’re spending our children’s inheritance”

No Joke

Apparently, this isn’t a joke. A December 13, 2013, article in CNN Money reported on a recent survey by the British-based international financial services company HSBC which asked more than 16,000 people in 15 countries about their estate plans. The US ranks last in the percentage of retired parents (56%) that intend to leave money to their kids. This is significantly below the 15-country average of 69% and far below the leading percentage of 86% in India.

US Rank

The US also ranks sixth in the amount of money ($177,000) that parents expect to pass on. This is behind Australia ($501,000), Singapore ($371,000), the UK ($234,185), France ($233,699), and Taiwan ($191,039).

No doubt there are many reasons for the country-by-country differences in what parents expect to leave their children. These may include differences in cultures, beliefs about family responsibilities, and attitudes toward charitable giving.

Contributing Factors

Other contributing factors, however, are differences in countries’ economic strength and tax laws. In a December 13 interview with The Australian, Graham Heunis, the head of retail banking and wealth management for HSBC Australia, credited some of the large inheritances there to the country’s unbroken 22 recent years of economic prosperity. Australian household wealth grew 7.6 per cent a year over the past decade, making it one of the richest nations per capita in the world.

Heunis also said, “In markets like the UK and US, inheritance and estate tax may cost heirs upwards of 40 per cent of an inheritance. With no inheritance tax in Australia, it’s no surprise the value and proportion of inheritance among Australian retirees is exponentially higher than the rest of the world.”

A Good Thing

It’s refreshing to see that accumulating and keeping wealth is still looked upon as a good thing in some countries. I doubt it’s a coincidence that most of those countries have strong economies, similar to what the US enjoyed in the past.

According to the 2013 Index of Economic Freedom, Singapore and Australia, the top two countries for inheritances, are two of the only three countries considered to have “free economies.” (The third is Hong Kong, where the average amount parents expect to pass on to kids is $145,943.) The US, considered the third top “free economy” in 2000, now sits at tenth as a “mostly free economy.”

Survey

This survey is not good news for baby boomers hoping to retire on inheritances from their parents. According to CNN Money, “About two-thirds of U.S. respondents said the inheritances they receive will at least partly fund their retirement, and 10% said they will rely on their inheritance completely to retire.”

If two-thirds of middle-aged Americans expect substantial inheritances, but only about half of elderly retired parents expect to leave inheritances, somebody is going to be disappointed.

Still, for those, like the majority of baby boomers, who are unprepared for retirement, every little bit helps. While an inheritance of $177,000 won’t put anyone on Easy Street in retirement, it could pay off a home mortgage or, if invested wisely, generate a monthly income of $450 for life.

inheritance

Another Problem

One last problem for potential heirs, of course, is that just because parents expect to leave an inheritance doesn’t mean they will be able to do so. Medical expenses or other unanticipated costs might well eat up parents’ resources during their lifetimes.

Assessment

Ultimately, relying on an inheritance for your retirement is never a wise move. It’s far wiser to use your own resources, start retirement planning early, and build your own financial security.

Conclusion

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Learn the “Right” Investing Lessons from 2013

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Understanding the Recency Effect

Lon JeffriesBy Lon Jefferies MBA CFP® www.NetWorthAdvice.com

The year 2013 was viewed as a very positive one by most investors; especially physician-investors.

The S&P 500 index (measuring large cap U.S. stocks) was up 32.39% for the year.

However, the reality is most other asset categories didn’t come close to keeping up with the pace set by U.S. equities.

For instance:

  • Foreign Stocks (IEFA): 22.46%
  • Emerging Markets (IEMG): -2.77%
  • Real Estate (IYR): 1.16%
  • US Government Bonds (IEF): -6.09%
  • US TIPS (TIP): -8.49%
  • Corporate Bonds (LQD): -2.00%
  • International Bonds (IGOV): -1.37%
  • Emerging Market Bonds (LEMB): -6.73%
  • Commodities (DJP): -11.12%
  • Gold (GLD): -28.33%

In Hindsight

In retrospect, the way to maximize your gain last year would have been to hold a completely undiversified portfolio consisting of nothing but U.S. stocks. The danger going forward is to learn the wrong lesson from 2013. Investors always have the temptation to fall prey to the Recency Effect, continuing and exaggerating the behaviors that worked in the recent past believing the environment we’ve just been through will be permanent.

The Long-Term Benefits of Diversification

Many will abandon their investment strategy because it didn’t give them the absolute best result last year, failing to recognize the long-term benefit of diversification. I’d argue that a better perspective is to remind yourself that the definition of diversification is that you always dislike a portion of your portfolio.

Always Laggards

Even in the most widely prosperous market environment, a truly diversified portfolio will have an element or two that lags the market. In fact, if at any time a portion of your portfolio isn’t generating negative returns, you should be concerned about a lack of diversification in your investment strategy.

Allocate Assets Now

Now is an ideal time to review your asset allocation and remind yourself why we diversify. Modifying your allocation with a focus on what happened in 2013 would be similar to guessing a coin flip will land on tails because it did on the previous flip.

Stock Market

Assessment

The correct lesson to take from 2013 is that over time, a well-diversified portfolio is capable of producing sufficient returns to help you reach your investment goals while minimizing risk.

Conclusion

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The 2000 Jaguar Touring Sedan [One of the finest luxury cars ever built – yesterday]

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About the JAGUAR XJ-V8-L [circa 2000]

By Dr. David Ewdard Marcinko MBA CMP™

Dr. David E. Marcinko MBAProof is in the long haul, of course [more than a decade for me], but it appears as if Jaguar finally threw off the curse of unreliability. Credit typically goes to many sources, but leading the pack has to be Jaguar’s prior owner, Ford, which has brought its mighty engineering and quality suppliers into the Jaguar picture. Tata Motors, today.

Based on my experience, the XJ8L represents the highest point in Jaguar’s history. Many think it’s one of the finest luxury sedans ever built. The Vanden Plas, named for a famous British maker of custom automobile bodies, is the most luxurious XJ8L, swathed in chrome, walnut and lambs wool.

As the XJ8 designation suggests, this is a V8-powered Jag. The V12 and inline 6-cylinder engines were discontinued with the 1999 models. The 4.0-liter V8 called a sweetheart was refined in 2000 to reduce emissions. Performance was not affected.

Jaguar’s XJ8 was available in four versions in 2000: Originally priced at $55,780 XJ8, the $60,830 long wheelbase XJ8L, the even more luxurious $64,880 Vanden Plas and the $69,030 supercharged and fully loaded XJR. Those prices compared favorably to those of the $66,970 BMW 740iL and the $74,495 Mercedes-Benz S420; back in the day.

2

Walkaround

Regardless of trim line, Jaguar’s XJ is a beautiful car. It is stately without being stuffy, and the soft lines are uniquely Jaguar. The 2000 XJ8 continued the design theme set in 1986; Jaguar tried horizontal, contemporary-looking headlights in the 1980s, but they were so universally assailed that the company came back with round lights and they are critical to the overall look.

The Vanden Plas shares the longer wheelbase with the XJ8L, which is 117.9 inches. The standard XJ8 and the XJR ride on a 113-in. wheelbase. Visually, that wheelbase extension is reflected in the length of the rear windows.

The powertrain, suspension and electrical system were new to the sedan. Tata now owns Jaguar and has brought financial support and technology to the company, which greatly benefited the XJ8. Electrical systems, electronics and other traditional Jaguar problem areas have been eliminated since Ford got involved.

The 4.0-liter V8 has double overhead-cams and four valves per cylinder. It produces 290 horsepower at 6100 rpm and 290 pound-feet of torque at 4250 rpm.

That impressive power is delivered to the rear wheels through a five-speed automatic transmission. This electronically controlled automatic adapts to varying driving conditions; it senses whether the driver is cruising along the highway, hot-footing down a back road or climbing a long grade and it varies shift points accordingly for optimum power and efficiency.

The transmission also had a self-regulating adaptive capability; it compensates automatically for the effects of aging by adjusting shift quality based on any slippage it detects. Sport and standard modes can be selected by the driver: The standard PRNDL pattern can be used, or shifts can be made manually by moving the stick to the left.

Automatic Stability Control comes standard on all Jaguars. ASC operates at all speeds, using engine intervention to reduce wheel spin on slippery roads. If a rear wheel starts to spin, the anti-lock brake (ABS) controller signals a computer, which controls the spinning by reducing throttle, retarding ignition timing or cutting fuel to the cylinders. This feature has been a bit problematic for me; and others.

An optional traction control system includes all ASC functions plus brake intervention. This system comes as part of the All-Weather package, which also includes heated front and rear seats. Both types of traction control can be switched off.

The front suspension is fully independent with unequal-length upper and lower wishbones, coil springs, shocks and an anti-roll bar. Double wishbones are also used at the rear with the drive shafts acting as upper links.

They are arranged for anti-lift under braking and anti-squat under acceleration. Variable-ratio rack-and-pinion power steering is speed-sensitive.

1

Interior

Jaguar’s uniqueness is especially evident inside my vehicle. Getting in is like sliding into an English gentleman’s club, with yards of supple leather, luxurious deep-pile carpeting, and polished wood on the doors, instrument panel and steering wheel. The instruments are simple and understated in keeping with the elegant mood.

Memory functions automatically adjust the driver’s seat, steering wheel and outside mirror. The driver’s seat moves back when Park is engaged for easy exit. It moves back to the last position it was set when the ignition is turned on. A [fragile] cup-holder pops out from the console, but any drinks in it tend to get in the way of shifting.

Thanks to the long wheelbase of the Vanden Plas, or L model, the rear compartment is huge and legroom is expansive. The bench seat has two depressed seating areas, but a third person would be comfortable in the middle. Airplane-like tray tables fold down from the front seatbacks. A small pod with two rocker switches on the left side of the passenger seat allows rear-seat passengers to move the seat fore and aft and adjust the angle of the seat back. Headroom is just as generous as legroom.

4

Driving Impression

The unique looks of the XJ8 and L are complemented by a driving experience all its own. Mercedes and BMW share a ride that is more on the firm side and generally feel tight and buttoned up. Lexus and Infiniti offer a softer ride and a more relaxed atmosphere. The XJ8L is wonderfully comfortable with an elegant feel.

Acceleration performance is startling with instant throttle response. On dry pavement, the Jag will light the rear tires up if the traction control is turned off. In a handful of seconds it’s hurtling past the speed limit. Jaguar says the XJ8 can accelerate from 0 to 60 mph in 6.9 seconds, an impressive feat given its size and weight at 290-horse-power. (The 370-horsepower XJR can do it in a mere 5.4 seconds.)

Shifting is silky smooth, even at full throttle. You can almost feel the transmission signaling the engine to reduce power slightly because a shift is coming. It’s an almost imperceptible pause as the shift is made.

I had some fun with the manual shifting mode, but it seemed superfluous with a transmission that does such a great job on its own. The manual operation is electronically controlled to prevent downshifting at an inappropriate speed. The gear can be selected, but the shift won’t be made until speed has dropped sufficiently.

Differences between Normal and Sport suspension modes are perceptible on rough surfaces and in hard cornering. The Sport setting lets a little more road roughness come through the steering, but gives the car a slightly flatter stance in cornering.

Driving on narrow roads, I discovered that the fenders loom large from the driver’s seat. The left front fender obscures the center line and the right front fender masks the verge to give the driver a feeling the car is taking up all the lane and more. But it isn’t; and we never posed a threat to mail boxes or other vehicles.

The steering lets the driver feel connected to the road, providing a strong sense of control. The wheels do not straighten by themselves after a tight maneuver; they must be brought back in line by turning the steering wheel, just like a race car.

Quiet is an expected part of the luxury quotient, but we didn’t expect this much quiet. It is so quiet inside it’s almost eerie. No wind noise, no road noise, no harmonics from various systems. You can hear the transmission as it reaches a shift point, and there is a sound you realize must be the engine, but it is more like an electric motor humming than a V8 combusting.

Visibility is good in all directions; but I find the headrests make it a bit cumbersome. The C-pillars are quite thin, so rear visibility is above average for cars this size.

Overall, my 2000 XJ-8L provides a very pleasurable driving experience.

3

Assessment

This is certainly one of the finest cars built – yesterday. Ford’s involvement has undoubtedly had a lot to do with that achievement. The old quality bugaboo seems to be just a memory.

BMW and Mercedes and the rest really can’t be compared with the XJ8, other than in price, because the Jaguar offers something altogether different. In price, however, the XJ8 or L was very competitive. For luxury with a difference, drive a Jaguar XJ8 or L series.

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The Impact of Rising Interest Rates on Bonds

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On Interest and Exchange Rates

Lon JeffriesBy Lon Jefferies MBA CFP® www.NetWorthAdvice.com

An interest rate hike has been widely anticipated for some time. According to an October survey of 50 top economists conducted by the Wall Street Journal, the yield on the 10-year Treasury was forecasted to rise nearly one percentage point to 3.47% by the end of 2014.

What impact would such a rise have on your investment or retirement portfolio?

The Impact

Christopher Philips, a senior analyst in Vanguard’s Investment Strategy Group, points out the historical inaccuracy of such forecasts.

For instance, a similar survey conducted in 2010 had economists predicting a 4.24% 10-year Treasury yield by the end of the year, an increase from 3.61% at the time of the forecast. In actuality, rates declines to 3.30% at year-end. The inaccuracy of these forecasts is well documented.

In fact, as Allen Roth mentioned in the December issue of Financial Planning Magazine, a 2005 study by the University of North Carolina titled “Professional Forecasts of Interest Rates and Exchange Rates” found economists predict future rates far less accurately than a random coin flip would fare as a predictor.

Clearly, we can’t be confident what interest rates will do in 2014, but what if economists are finally correct and rates rise? How damaging would an interest rate increase be for bonds? If interest rates rise one percentage point next year, the intermediate aggregate bond index is expected to lose -2.8% — far from catastrophic. Of course, such potential risk is notably minimal when compared to the downside of owning stocks (remember the -36.93% loss endured by the S&P 500 in 2008?).

Historical Performance

It is also interesting to study how bonds have historically performed in periods of rising interest rates. Craig Israelsen, a BYU professor, recently documented how bonds performed during the two most recent periods of rate increases. Israelsen points out that although the federal discount rate rose from 5.46% to 13.42% from 1977 through 1981, the intermediate government/credit index had a 5.63% annualized return during that period. The next period of rising interest rates was from 2002 through 2006, when the federal discount rate had a fivefold increase: from 1.17% to 5.96%. During this period, the intermediate government/credit index obtained a 4.53% annual return. Clearly, even in an environment of rising interest rates, bond performance was surprisingly strong.

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Muni Bond Underwriters

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Most importantly, investors should never forget the value bonds add to a portfolio as a diversifier to stocks. Frequently, the performance of stocks and bonds are inversely related.

For instance, when the stock market suffered during the tech bubble crash of 2000-2002, the Barclays Long-Term Government Bond Index rose 20.28%, 4.34%, and 16.99% in those years, respectively.

Current Indices

More recently, when the S&P 500 lost -36.93% in 2008, the Long-Term Government Bond Index rose 22.69% during the year. This diversification benefit may prove useful when stocks ultimately cool off from the extended hot streak they have experienced since 2009.

In 2013, the Aggregate Bond Index decreased in value by -1.98%. Given the occasional negative correlation in performance between stocks and bonds, is it really surprising that bonds didn’t produce a positive return given the incredible year stocks had (S&P 500 up over 32%)? Additionally, held within a diversified portfolio, isn’t the -1.98% return produced by bonds during the recent equity surge a small price to pay for the additional security they are likely to provide when markets reverse?

Assessment

It doesn’t seem prudent to avoid bonds entirely during periods of expected interest rate increases.

  1. First, forecasts of rising rates are far from certain.
  2. Second, even if interest rates rise bonds are still likely to be far less risky than stocks.
  3. Third, rising interest rates don’t necessarily mean declining bond values are a certainty – in fact, bonds performed quite well during the past two periods of rate increases.
  4. Finally, bonds are a vitally important part of a diversified portfolio, and owning uncorrelated and negatively correlated assets will be critical when equities ultimately lose their momentum.

Conclusion

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The Associated Press “American Dream”?

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On Changing Definitions

By Rick Kahler CFP® http://www.KahlerFinancial.com

Rick Kahler CFPThe surest road to financial success and independence is a long one. That path includes working hard at a career you enjoy, living on less than you earn, taking educated and appropriate risks, and building wealth gradually through diversified investing.

The American Dream

I know many people who have followed this route successfully. Their achievement—what has long been described as the American Dream—should be something to be proud of.

The Associated Press

Apparently, in today’s world, that isn’t the case. At least not according to an Associated Press news article published in the Rapid City Journal on December 9, 2013. The headline was straightforward enough: “Rising riches: 1 in 5 in US reaches affluence.” The article stated that 20% of Americans will have household incomes of $250,000 or more at some point in their lives. This includes those with high incomes for only one year or a few years. During those periods of affluence, they are in the top 2% of earners.

AP Inaccuracies and Assumptions

Beyond that, the piece was filled with inaccuracies and assumptions.

First, its writers confused “affluence” and “wealth.” Someone with a high income in a given year is affluent. Anyone with a basic grasp of finance, however, understands that wealth is associated with net worth. When only 2% of Americans have a net worth of $1 million or more, 20% can’t be accurately described as wealthy.

A One Time Affluent Deal

Some high earners are two-income couples, or professionals like physicians, at the peak of their careers. For others, affluence is a one-time deal.

Consider this example: A couple in their 50’s have always earned around $40,000 a year (adjusted for inflation). The husband inherits a $250,000 IRA from his parents. The couple decides to distribute the money in the IRA, pay the income taxes, and use the balance to pay off their mortgage. For that one year only, their income exceeds $250,000. That certainly isn’t enough to earn the label of “new rich.”

The article notes these “new rich” tend to be “much more fiscally conservative” than other Americans and “less likely to support public programs, such as food stamps or early public education to help the disadvantaged.” This makes anyone who ever receives over $250,000 in any one year look like Ebenezer Scrooge before his transformation. but it is true.

Windfalls

Ask anyone, no matter how liberal, who received a windfall in 2013 and watched 25% to 50% of it disappear to federal and state income taxes, whether they are happy about this income redistribution.

The AP also notes the number of people reporting income of over $250,000 doubled since 1979, leaving the impression that the rich are getting richer while the poor are getting poorer. While this is technically correct, the figures are meaningless because they are not adjusted for inflation.

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Accenture’s Institute for High Performance and Research

The article also cites Paul F. Nunes of Accenture’s Institute for High Performance and Research, in support of its contention that those who are newly or temporarily affluent aren’t spending enough. Their “capacity to spend more will be important to a U.S. economic recovery.” Instead, they “spend just 60 percent of their before-tax income, often setting the rest aside for retirement or investing.”

Taking Care of Business

In other words, these successful Americans are doing exactly what the American Dream says they should do. They are taking care of themselves and planning for the future by working to build their short-term affluence into lasting wealth and financial independence.

Assessment

For this, they should be applauded. It would be more helpful to our country, economically and socially, to see them as role models rather than part of the problem. Instead of trying to bring successful people down, we would achieve more by using their example to lift others up.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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ACOs and Marketplace Competition

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An Estimation of Material Impact

By www.MCOL.com

ACOs

Assessment

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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On Items NOT Purchased in the Sale of a Medical Practice

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Excluded – Not Included – Items

By Dr. Charles F. Fenton III JD

fentonMuch is written about the sale of a medical practice: price, taxes, terms, loans, negotiations and FMV etc; especially on this ME-P by Editor Dr. Dave Marcinko and his team. Excellent thoughts, all! But, little is written about items not purchased.

So, here is a different perspective.

Excluded Items

Items not purchased or “excluded items” often list the personal items of the parties – or of the employees of the parties. Such items would often include:

  1. All cash on hand or on deposit;
  2. All accounts receivable generated prior to the closing date;
  3. All prepaid expenses, utility deposits, tax rebates, insurance claims, credits due from suppliers and other allowances after Closing Date;
  4. The personal effects, including but not limited to; photographs, diplomas, uniforms, books, mementos, memorabilia, personally owned art objects and any other personal property owned by them;
  5. Life insurance, disability insurance, and disability buy-out insurance on seller;
  6. Motor vehicles used in connection with the practice;
  7. Any and all tangible and intangible assets used in conjunction with another practice of seller; and
  8. All other assets owned by seller other than those specifically described as items purchased.

ME-P medical malpractice education

Assessment

The exact items transferred will often depend upon the prior negotiations of the parties.

For example, the parties may have agreed that the accounts receivable will be transferred with the practice. In such an instance, the accounts receivable will be listed as an item to be purchased.

MORE:

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Are FAs a Wise Investment?

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Ask-the-Advisor

Dear Dr. David Edward Marcinko,

Dr. MarcinkoAre financial advisors a wise investment? Mine charges me 1% each year for all my assets under their management. Is it worth it?

—Allen

It is hard to know for sure. But the fact that many financial advisers have different hidden fees suggests to me that they themselves don’t think that people would pay if they charged for their services in a clear and upfront way.

Re-Frame

To help you think about this question in your own life, let’s contrast two cases: In case one, you are charged 1% of your assets under management, and this amount is taken directly from your brokerage account once a month. In case two, you pay the same overall amount, but you send a monthly check to your financial adviser.

Consider

The second case more directly and clearly depicts the cost of your financial adviser, providing a better frame for your question. So, put yourself in the mindset of the second case, and ask yourself if you would pay directly for these services.

I think the best answer, according to colleague and economist Dan Ariely PhD, can be expressed in this manner.

If the answer is yes, keep your financial adviser; if the answer is no, you have your first action plan for the New Year.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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My Experience with ObamaCare

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Not a Unique Story – to Date

Rick Kahler CFPBy Rick Kahler CFP® http://www.KahlerFinancial.com

Like millions of Americans, I jumped on Healthcare.gov on October 1 to view the long-anticipated plans on the insurance exchanges mandated by the Affordable Healthcare Act, known as Obamacare. I needed a new healthcare plan and purposely held off buying one in September to compare the coverage and prices of an Exchange plan.

My disappointment paralleled that of thousands of other Americans wanting to do the same. After six tries that day, I gave up. I tried the site multiple times for each of the next six days. No luck.

The Short Form

Finally, on the seventh day, the site actually let me start an application. I chose to go with the “short” form since I was certain I would not qualify for a subsidy.

The short form application took 30 minutes to fill out. There were very few questions about health, just whether anyone in the household smoked. A number of questions had me wondering if I was applying for a passport. These included my Social Security number, race, citizenship, relationships to everyone in the family, and whether I was ever incarcerated.

When I reached the end of the form, I hit “submit,” anticipating that plan options and costs would appear. Instead, I was sent back to the starting page of the form. After 60 minutes of trying to get out of this endless loop, I gave up.

Three More Weeks of Trying

For the next three weeks, I went to the site at least once a day. I was never able to get past the endless loop to view plans or prices. I took a two-week break.

On November 14, I tried again. Success! Well, sort of. No endless loop. Instead, the site said it lost my original application and I needed to complete a new one. After another 60 minutes filling out the application, I ended up stuck in a loop again, unable to view plans or prices, much less choose one.

Giving Up

Frustrated, I decided to give it a rest until the site re-launched on December 1. I figured I would still have plenty of time to meet the December 15 deadline for enrollment.

On December 1, I eagerly popped onto the site. Not only was the site not functional, it had lost my application for the third time.

I gave up.

Enter the Insurance Broker

I phoned my insurance broker. She was able to give me all the information I had tried to get out of healthcare.gov for the past 60 days. She also said my insurance company was canceling my current plan. Obamacare deemed the coverage substandard because it did not cover pregnancy, mental health costs, and pediatric dental and vision costs. Although I don’t want or need any of that coverage, Obamacare gives me no choice.

Prices

My old policy cost $1,192 a month. The new one costs $1,506, which includes $59 a month in mandated surcharges on non-exchange policies to help fund Obamacare. My maximum family out-of-pocket expenses must also increase $208 a month. The total potential increase is a staggering $524 a month.

###

Obama Care

###

A Skeptic

As someone who listened with great skepticism as politician after politician promised that Obamacare would lower health care costs, lower our deficit, and guarantee we could keep any existing plan, I feel sadly vindicated. In March 2010, when Congress passed Obamacare, I paid $660 a month for health care that had better coverage than I have now. For that same coverage today, my premium would be $2,450 a month.

Assessment

Unfortunately, my story is not unique. It is ubiquitous to the average American who has health insurance. Our elected officials and government agencies failed us miserably. So far, there appears to be no relief in sight.

More

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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On Bull Markets under Democrats

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A Political Discourse by Kevin Outterson

[By Staff Reporters]

The Dow hit an inflation adjusted record high this week (WSJ). Here is the (unadjusted) S&P since 1975 with Republican administrations in red and Democrats in blue.

chart

Before you jump to partisan conclusions, last month, Tyler Cowan reviewed the Blinder and Watson paper on why Democrats preside over superior economic performance (their conclusion: mostly good luck).

Source: Bull markets under Democrats

More:

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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The Business of Christmas 2013

X-Mass Illustrated

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XMass

With Christmas today, we thought it would be fun to post an infographic on the business of Christmas.

From the explosive growth of online shopping to the top selling Christmas gifts of different decades, we’ve got it covered.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Seeking Securities Analysts, Stock-Brokers and Investment Bankers for New “Financial Planning Textbook for Doctors”

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Planning our newest major textbook

By Ann Miller RN MHA [ph-770-448-0769]

[Executive-Director]

Dear Stock Brokers, IBs and Securities Analysts,

Greetings from the Institute of Medical Business Advisors, in Atlanta, Georgia.

Historical Review

As you may know, we released: Financial Planning Handbook for Physicians and Advisors, some time ago. It has enjoyed much success and acclaim in the medical and financial service sectors.

Recently, we have been asked to produce the next edition of this book for our target market of physicians, nurses, medical professionals, healthcare administrators – and those in the financial services sector who target this large and fertile, but rapidly changing niche market.

Why Now?

Urgency for the update has been prompted by ARRA, HI-TECH, the flash-crash of 2008 and the day-crash of 2011; by social, macro-economic and demographic changes; by political fiat and especially the PP-ACA.

Our medical colleagues are frustrated, afraid and fearful for their financial futures. They WANT informed advice.

Thus, true integrated financial planning information that targets this market – very expertly and specifically – is greatly needed.

The Invitation 

And so, we ask if you are interested in contributing an updated vision of an existing book chapter.

  • INVESTMENT BANKING-SECURITIES-MARKETS-MARGIN
  • HOSPITAL EMPLOYEE BENEFITS AND STOCK OPTIONS
  • INVESTMENT POLICY STATEMENT CONSTRUCTION

Not to worry – The original MS-WORD® chapter files are archived and available for use. We will forward it to you, upon assignment acceptance.

And, we are again fortunate that our Editor-in-Chief will be Dr. David Edward Marcinko FACFAS MBA CMP™ along with Professor Hope Rachel Hetico RN MHA CMP™ serving as Managing Editor.

They opined at a recent interview for the ME-P.

David and Hope” … We have entered into an emerging era in the financial planning ecosystem. It is a new era where one size does not fit all; and off-the-shelf financial products and mass sales customization is no long adequate for physicians and medical professionals; or their related generic financial planners or wire-house advisors.

It is a period of rapid change, shifting reimbursement paradigms and salary reductions that focus the healthcare industrial complex on pay-for-performance [P4], compensation for value and quality care; rather than procedures performed and quantity of care.

All must learn to do more with less professionally; and plan their personal financial lives more efficiently than ever before. Mistakes will be more difficult to overcome and the wiggle room that high income earning physicians, nurses and medical professionals used to enjoy is being narrowed by demographic, economic, social, technological and political fiat.

This emerging financial planning analog follows the health industry’s fiscal metamorphosis …”

Style Instructions 

The look and feel, format and style, and font and size of the book will remain the same. We use endnotes, not foot notes; and include mini-case reports or illustrative case models. It will be a major text; not a handbook.

Timeline for submission is about 3 months. Additional time is available, if needed, for a comprehensive update. But, we are trying to avoid running too far along into 2014 in order to avoid income tax season and the related time constraints on all concerned.

Writers Search

A Pleasure – Not Burden 

This should be a pleasurable project for you; and not anxiety provoking.

So, if you are a medically focused and experienced financial advisor with an: MBA, CFP®, PhD, MD, DDS, MSA/MS, CPA, RN, CMP®, DO, JD and/or CFA degree or designation, etc; please let me know if you are interested in updating and revising our chapters. OR, authoring a new to the world chapter.

Your Payback 

In return for your conscientious industry, you will receive a complimentary edition of the entire textbook; be listed on this ME-P as thought-leader with related book advertising content attributed to you; and given e-exposure to our almost 600,000 readers and ME-P subscribers …. Such the deal!

And, you will be added to our roster of experts for potential referrals, interviews, pod-casts and other marketing efforts

Assessment

Regardless of your decision, we remain apostles promoting your core vision of physician focused financial planning whenever possible.

Or, you may suggest another possible author- writer-expert contributor; if you wish.

Just let me know; ASAP [MarcinkoAdvisors@msn.com]

Thank you.
ANN
ANN MILLER RN MHA
[Executive-Director]
INSTITUTE OF MEDICAL BUSINESS ADVISORS, INC.
Suite #5901 Wilbanks Drive
Norcross, Georgia, 30092-1141 USA
[Ph] 770.448.0769

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com 

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NOTICE: This invitation is not for all readers of the ME-P. It is a privilege invitation intended for those who possess the needed credentials, as decided by us, with an inclination to serve.  We reserve the right to accept or reject contributors, and content, at our own non-disclosed discretion.

##

On Health Websites and “Apps”

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Not Just a Fad – Anymore

By Jennifer Tomasik, Carey Huntington and Fabian Poliak

http://www.CFAR.com

Jennifer Tomasik

Health Information Technology [HIT] may have arrived slowly into clinics and insurance companies, but the pace of innovation and adoption in consumer electronics today is astounding (and accelerating).

Devices are quickly penetrating every facet of our lives in the form of laptops, smartphones, tablets, and beyond. Thousands of health and wellness websites and software applications (“apps”) already exist, and we believe their role in healthcare will be increasingly a central one. Some are crucial elements of health organizations’ programming, such as the online platform that ShapeUp is built on: www.ShapeUp.com

Are they Effective?

Many are stand-alone tools without an organization or programming per se—i.e. apps for counting calories, monitoring glucose levels, or tracking sleep. But are websites and applications effective means of engaging individuals in their own health? And if so, what separates the good ones from the bad ones?

The Data

A 2009 meta-analysis of web-based smoking cessation programs found the pooled quit rate for participants to be 14.8% after follow-up conducted three months out, and 11.7% after six months out. [i] These figures are an improvement over the rate of people attempting to quit without any help or resources, as previously cited.

Internal Studies

From our own study of health websites and applications, we are beginning to see that high-quality digital resources share many of the same characteristics as great products and services do in the physical world. They create pull by engaging users via explicit reward structures. They enable teamwork and foster social accountability. Their content is interactive, informative, and often individualized. Their use is intuitive, convenient (e.g. accessible by web on a laptop or tablet and by smartphone “mobile apps”), and even effortless to the user (e.g. automatically collecting, synchronizing, and analyzing information).

Apps

Fragmentation

The fragmented world of websites and applications is not without its problems.

In today’s “app market,” the void that many websites and applications fill is not necessarily in the best interest of “health consumers,” and the quality of their products or services is often questionable. We see such issues as a reality of any market in its early stages.

Assessment

However, we are optimistic that greater consultation with medical professionals, greater investment and competition among health organizations, and improved regulation can help this new market mature into an indispensable virtual ecosystem of resources for health-seeking individuals.

More:

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors


[i] Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. “Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials.” Arch Intern Med 2009;169(10):929-37.

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On Investment Insurance?

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Guaranteed living Benefits

Rick Kahler CFPBy Rick Kahler CFP® www.KahlerFinancial.com

Many investors, panicked by the market crash of 2008-2009, started a search for some type of investment vehicle to protect them from the next market downturn. Some decided the answer was a variable annuity with a “guaranteed living benefit” rider.

Insurance

At first blush, this seems to be a good use of insurance. For a nominal cost, insurance helps us spread the risk of a catastrophe. Consider auto insurance. There is a very small chance I will total my car in the next year. It’s hard to predict whether that will happen, but one thing is sure, it is all or nothing. Either I will or I won’t.

However, predicting the number out of a large group of people who will total their cars becomes much easier. While we don’t know who will total their cars, we do know about what percentage of people will. This predictability allows an insurance company to determine the average number of claims and set an annual premium that covers the anticipated claims and generates the company a profit.

Market Crashes

Insuring market crashes works much differently. Michael Kitces, in his Nerd’s Eye View blog post of November 20, explains, “The problem with trying to insure against a market catastrophe is that the risks don’t ‘average out’ over time, instead, they clump together.” In other words, the insurance company has either no claims or 100% of their policy holders having claims.

Why? When insuring against a stock market decline, there are absolutely no claims when markets trend upward. However, when markets head down, every policyholder potentially has a claim. Kitces notes that usually “companies are very cautious not to back risks that could result in a mass number of claims all at once. This is why most insurance policies have exclusions for terrorist attacks and war.”

Policies

To help insure against this concentrated risk, the companies use several methods to design these policies. One is to collect a fee for the guarantee that funds a reserve to offset potential losses. Kitces says this fee is so “tiny” that it “just doesn’t cut it.” He gives an example of a company with $300 billion of guaranteed annuities where the market declines 25%, exposing the company to a $75 billion loss. A guarantee fee of 0.5% is only $1.5 billion, not enough to even begin to cover the losses.

Loss Mitigation

Another way the companies mitigate their loss is that, unlike auto insurance, these policies do not pay immediate benefits. If the market drops by 50%, you don’t get a check for your original investment plus a fair return for the time they had your money. What you get is a promise to pay you a lifetime stream of income, usually at some date in the future. If you had a portfolio of mutual funds holding thousands of companies and purchased a “guaranteed living benefit,” you actually transfer the diversified risk to one insurance company that has actually concentrated, rather than spread, the risk.

Variable Annuities?

Does this mean you should avoid variable annuities? No, as not all of them concentrate their risk. Most allow you to invest in a broad range of securities and spread your risk. Consider avoiding annuities that have a “guaranteed living benefit” and fees of over 1%.

Stock Market

Other Options

Kitces cites two other options for investors. One is to keep your portfolio invested in mutual funds that hold a broad selection of securities and simply lower your risk by owning less equity and equity-like investments and more bonds.

A second is to spend less, keeping your withdrawal rate under 3%.

Assessment

Practicing both of these strategies is a way of providing your own insurance against market crashes.

More:

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Pity the Poor Hospitals?

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A Historical Look-Back to the Future?

wayne-firebaugh

By Wayne Firebaugh CPA, CFP® CMP™

www.CertifiedMedicalPlanner.org

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future. … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

In Agreement

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Today

More current healthcare statistics after the November 7th 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression.  The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

  • Hospitals provided $39 billion in uncompensated care to patients in 2010 representing 5.8% of their expenses.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.

More Metrics

A further review added more daunting numbers: [3]

  • In 2010, 22.4% of hospitals reported a negative total margin.
  • From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
  • Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
  • The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
  • From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment?

Latin Roots

The same Latin words that give rise to the word “dowry” also give rise to the word endowment.[4] Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance.

With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Hospital

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

More:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors


[1]   MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2]   Steinberg, C. Overview of the U.S. Healthcare System.  American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3]   “Trends Affecting Hospitals and Health Systems.”  TrendWatch Chartbook 2010.  American Hospital Association (2010).

[4]   Merriam-Webster Online.

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The AHRMM Stance on Comparative Effectiveness Research [CER]

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Association for Healthcare Resource & Materials Management

By Adam Higman

By Brian Mullahey

By Kristin Spenik

By Jerzy Kaczor

http://www.SoyringConsulting.com

In today’s hospital setting, data and healthcare information is the most accessible it has ever been making it necessary for healthcare professionals to assess and evaluate its accuracy.  Additionally, the healthcare supply chain is filled with “me-too” products with often dubious improvements in clinical efficacy over competitive and legacy products.

The AHRMM Issues & Legislative Committee

AHRMM’s Issues & Legislative Committee has advocated the usage of Comparative Effectiveness Research (CER) to offer substantial, evidence-based data to aid healthcare organizations in their purchasing decisions.  CER data includes unbiased conclusions regarding healthcare products and supplies, after having compared the advantages, usefulness, and possible harm of numerous pharmaceuticals, medical devices, equipment, surgical procedures, and tests for specific disease states and treatments of care.

Adult-Resources

Goals

By utilizing the CER-provided data, materials management professionals can :

  • Warrant top-performing Value Analysis Committees
  • Verify the cost-effectiveness and ability of salvaging “single use items”
  • Regulate Medical/Surgical products
  • Capitalize information technology efforts to decrease expenditures and inaccuracies
  • Change supplies, services, and technologies to lower budget-friendly, clinically-acceptable options that endure needed specifications
  • Convert to supplies, services, and technologies that produce better patient outcomes at a lower total cost that meets needed specifications
  • Prioritize capital expenditures
  • Use third-party benchmarking tools to get the most out of resources 2

More:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Unusual Forms of Property and Liability Insurance for Doctors

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Coverage Types

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Dr. Marcinko 1972 VetteObviously, not all forms of insurance coverage can be described in detail on this ME-P. That’s where our books are useful.

However, as a licensed P&C insurance agent for more than a decade, the healthcare professional or medical practitioner should consider other forms of commercial property and liability coverage not considered the “norm.”

Directors and Officers Liability Insurance

The officers and directors of large practices, or healthcare facilities can be held personally accountable, and thus liable, for breaches of their duties by a number of parties.

Commercial Automobile / Vehicle Insurance

As the name suggests, this coverage provides protection for any commercial vehicles owned and operated by the healthcare corporation.  If the practice or facility owns automobiles or other vehicles that are used in the “usual and customary” business activities, this coverage is required.  The policyowner should be aware of the nine classifications of automobiles insured to ensure that coverage is appropriate.

Commercial Umbrella Liability Insurance

This coverage is very similar to the umbrella coverage discussed under the personal coverage area.  Again, risks above the limits established by the underlying commercial liability coverage trigger the umbrella policy.  The word of caution for this coverage is “Read the Provisions Carefully” as there is little standardization among insurance companies.  Make sure the umbrella policy covers what you want it to cover, with the right limits of benefits and “trigger” points, with proper exclusions, and proper endorsements (if being used specifically for a medical practice).

Employee Benefits Liability Insurance

Virtually each medical practice or healthcare facility has employee non-cash benefits in addition to their payroll.  These benefits usually include group insurance and some form of retirement plan (a 401(k), for example).

However, each of these benefit packages exposes the employer to liabilities under state and federal statutes.  Employee Benefits Liability Insurance covers an employer, or if so stipulated by some policies, the employees who act on behalf of the employer, against liability claims involving alleged errors or omissions, or improper advice or administration of the employee fringe benefit plans.

For example, an employer may be liable for not enrolling an employee on a timely manner resulting in no medical coverage.  Frequent litigation also arises out of violations of the Employee Retirement Income Security Act (ERISA) of 1974.  Since 1974, the provisions and reach of this Act has become massive and errors can occur.

WELCOME: The ME-P Insider's Network

Assessment

Can you think of any other forms?

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Percentage of Americans Putting Off Medical Treatment Because of Costs

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Do we really know?

www.MCOL.com

Health costs

Assessment

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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What is Form 834?

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President Obama’s Most Important Number

[By Staff Reporters]

This is an “834 EDI transmission.”

Health Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see on the Federal Website. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And, it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

Washington Post Article:

This is an “834 EDI transmission.” Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

HIEs

What is the ANSI 834 Enrollment Implementation Format?

The 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

In 2004, DHCS implemented a 4010 834 solution, however, this was implemented along with a supplemental transaction that held eligibility history.

The HIPAA 5010 version of all transactions is scheduled to be implemented on January 1st, 2012. DHCS will implement a compliant 5010 834 on this date. The current FAME file will continue to be made available for a short period of time after this date to allow plans time to transition. Once this transition period has been completed the FAME file will no longer be made available to managed care plans.

Impacted Covered Entities

Internal DHCS program areas and DHCS Health Plan trading partners.

Links:

5010 834 Documents

General FAME Documents

MEDICARE PART D INFORMATION

Project Information

DHCS Medicare Part D information web page

MMA Part D Carrier Cross Reference Table (pdf)

File Layouts

MMEF 2100 Medicare Part D layout (pdf)

MMEF REC Medicare Part D layout (pdf)

Assessment

best-diagram

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Medical Practice as a Portfolio Asset Class?

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Valuing the Quintessential Alternative Investment

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief] www.CertifiedMedicalPlanner.org

Dr. MarcinkoAs all FAs, and informed physician investors know, the investment industry and Modern Portfolio Theory [MPT] strives to make optimal ‘allocations’ into different ‘asset classes’; according to some defined risk tolerance level or efficient frontier.

Equities, fixed income, property, private equity, emerging markets and so, are all ‘asset classes’, into which physician investors and mutual fund or portfolio managers will make an allocation of their total funds under management. It is quite proper for them to do this as they seek to balance the risk and potential returns for their own; ME, Inc., or other clients’ money.

But, by creating a “new” asset class, this concept opens the door to significant capital flows; advisory and management fees. Hence; the unrelenting innovation of Wall Street, and its’ commission driven and fee-seeking mavens, is unending.

Making an Impact

This secular and non-secular concept is broadly known as “impact investing”; and may be illustrated using Social Security as an example.

So, Wall Street opines,  if you’re not counting on Social Security benefits as a part of an overall asset allocation strategy, you may be missing out on bigger gains in a retirement portfolio. Those of this ilk say that retirement investors should consider the value of their Social Security as a portion of their fixed-income investments. Others believe it may be too risky for some.

The Strategy

Generally, adopting such strategy would mean shifting a big portion of investible assets out of bonds and into stocks. And, into the hands of money managers, stock brokers, wealth and endowment fund for a fee; of course. This is akin to those financial advisors who rightly or wrongly goaded clients a decade ago, to not pay off a home mortgage and instead reposition the free cash flow into a rising; and then falling; market.

Of course, there are detractors, as well as proponents, of this emerging financial planning philosophy.

Vanguard Group

Jack Bogle, founder of the Vanguard Group, often cites his penchant for basing one’s asset allocation on age. (If you’re 40 years old, you have 40% of your investments in fixed income and 60% in equities. By the time you’re 60, you’ve got 60% in fixed income, 40% in equities).

Example:

So, let’s consider Social Security, citing a physician with $300,000 in an investment portfolio, and capitalizing the stream of future payments.

If the $300,000 is all in equity funds, even equity-index funds, and $300,000 in Social Security, you are already at 50/50″ fixed income versus equities.  The next step is a conversation as a DIYer or ME Inc physician investor or advisory client. This is the nexus of where Social Security meets risk management.

Now, how will the doctor feel when market goes up and down? Some may believe the concept, but not enjoy the inevitable more fluctuating self-directed 401-k, or 403-b plan. So, one must be comfortable with taking on a larger stock position.

Source: Andrea Coombes; MarketWatch, September, 2013.

http://money.msn.com/mutual-fund/social-security-as-part-of-your-portfolio

MD

The Negative

Others experts, like Paul Merriman, opine that Social Security is not an asset class and the idea is fundamentally flawed and should not be a part of anyone’s portfolio.

Why? As classically defined, a portfolio is composed of financial assets. A financial asset is something that can be sold. Social Security cannot be bought and sold. Because of that, it has a market value of zero.

Source: Paul Merriman, MarketWatch, November 2013

Assessment

Therefore, the definitional decision is left up to the informed reader, modern physician or enlightened advisor. Is a medical practice an asset class?

MORE: About iMBA Inc Expertise in Healthcare Valuation

MORE: Social Security as an Asset Class?

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Take the Accountable Care Organization 2013 e-Poll

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TAKE THE POLL

www.MCOL.com and Accountable Care News are conducting the 2013 Accountable Care e-Poll. Please respond by 5 PM Pacific, Friday December 13th, 2013. Results will be emailed to participating respondents upon request.

e-Poll

You can take the e-poll by going to: http://aco2013.questionpro.com/
The e-poll asks the following questions:

  1.  Please indicate your perspective:
  2. Is your organization involved with ACOs- including development, operation, or contracting arrangements?
  3. When would you estimate ACOs would have a material impact in your marketplace:
  4. If ACO Medicare pilots are not ultimately successful, will that cause commercial and Medicaid ACO arrangements to generally fail as well?
  5. What will be the impact of the newly enrolled individuals coming into the system as a result of Medicaid expansion and the health insurance exchanges?
  6. How confident are you that ACOs will actually generate the necessary savings?
  7. Will bundled payments prove to be a more effective delivery and payment reform model than ACOs?

Advocacy

Assessment

Again, to take the e-poll now, go to: http://aco2013.questionpro.com/

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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ME-P Picks [Public Viewpoints on Health Reform and Policy]

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By Staff Reporters and related sources

By http://www.MCOL.com

 Delolitte Employer Poll Gives Grades From 500 employers Regearding Healthcare Reform

  1. 33%  would give a grade of an A or B
  2. 38% say a C is an appropriate letter grade
  3. 29% believe a D or F would be more appropriate
  4. 22% of employers say the ACA will reduce costs by the year 2019
  5. 19% said it will improve quality of care by the year 2019
  6. 50% of respondents said it will widen access to health insurance.

Source: Deloitte

Some more new Lists:

Health Insurance

Assessment

Visit: www.CertifiedMedicalPlanner.org

Conclusion

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On Healthcare.Gov System Availability

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A Review of Website “Uptime”

By www.MCOL.com

HG

Conclusion

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Seeking a Physician Leader of Population Health Management‏

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Centene Corporation Seeking Medical Director

By Paul Esselman

Dear Dr. Marcinko,

Centene Corporation is seeking a Medical Director to manage its newly formed health plan, Arkansas Health & Wellness Solutions.

Based in Little Rock, Arkansas with its core operational functions handled by NovaSys Health, this plan has been approved to participate as a Qualified Health Plan issuer in the Arkansas Health Insurance Marketplace.

The Medical Director will work with a well-established provider to help build a new business line from inception; partnering with NovaSys senior leadership, s/he will assist in development of a medical management infrastructure to position the organization to expand its membership with the Medicaid patients in the state.

Centene-Corporation

Assessment

I would welcome your thoughts as to whom I may contact regarding this highly visible role.

Kind regards,

Paul Esselman
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
314.236.4588 Office
pesselman@cejkasearch.com
http://www.cejkaexecutivesearch.com

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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How You Can Financially Profit from the PP-ACA?

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An Obamacare Sales Opportunity

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief] www.CertifiedMedicalPlanner.org

Dr. MarcinkoPresumably, as a result of my financial advisory activities, I received this email solicitation the other day,

So, I thought I’d pass it along [unchanged] to our ME-P readers, FAs, insurance agents and subscribers for comment.

USA BENEFITS GROUP EAGLE DIVISION  ………. PROVIDING CAREER SOLUTIONS FOR 36 YEARS 

[Better Contracts + Better Schedule + Better Career Opportunities] 

Dear Prospect [that would be ME],

I received your resume on Monster.  You already know that the real money in any organization is in sales. The salespeople of the world make things happen and are highly rewarded for that work.  But it’s hard work.

The Product

What if you could find a product that everybody needs, that they have money budgeted to purchase, and are looking for someone to help them buy it?  Do you think you could help that person? That’s exactly  the situation in the health insurance industry today!

Our government is telling people they HAVE to have it.  Folks are either buying it now from somewhere or will soon be eligible for subsidies so they CAN buy it.  And EVERYONE is confused and looking for someone with answers on how to get this product!

You can be that Person

Over the next sixty months, billions of dollars are going to change hands as people readjust to a dynamic health care environment.  How can you get into the river and get your hands on some of that money?  By preparing to serve people!

USA Benefits Group 

The USA Benefits Group is a highly successful team of insurance brokers who are “reform ready” – staying up to date on this perhaps once-in-a-lifetime shift in this industry.  We are independent, non-captive agents who are setting up qualified, turn-key “private exchanges” to help people obtain health insurance in a webinar-based setting from our home offices.

I’m encouraging you to click here: www.usabg.net/dcollins to learn more. If you’re serious and ready to make a move, you can call me toll-free now at 866-328-6182. If you’re qualified, I also have Regional Management positions available.

Advantages of working with my Eagle Division 

  1. 1. 36 year old system for success
  2. 2. 100% control of your future
  3. 3. Equal opportunity
  4. 4. Recession proof
  5. 5. Top Companies to represent
  6. 6. Excellent co-op lead program
  7. 7. Weekly advance commissions ($2,000 To $4,000 Net Weekly)
  8. 8. Vested Lifetime Renewals ($10,000 To $20,000 Monthly In Under 3 Years)
  9. 9. Annual Incentive Trips
  10. 10. Annual Production Bonuses to $50,000+

I’m looking forward to talking to you.
David Collins
DIVISION MANAGER
866.328.6182
DC@usabg.net

Assessment

  • Is this a good product to sell? If so, why does it need an intermediary to push it?
  • Don’t subsidies, carve-outs, exemptions and sales commissions serve to jack-up price and lower quality? [think eMRs]? What about the overall cost of healthcare delivery; up or down?
  • What about the USA Benefits Group; credible or not? Are cold calls the way to go?
  • What is your impression of Division Manager Mr. David Collins and his Eagle Division? Feel free to contact him … and tell him what you think.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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A Mobile Health “apps” Opinion Survey

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Original Research Opportunity

By Thomas Martin [Doctoral Candidate]

[School of Public Policy and Administration]

University of Delaware – trm@udel.edu

[412-992-1285]

Dear Dr. Marcinko and ME-P Readers and Subscribers,

The University of Delaware is conducting research to assess medical provider attitudes towards applications “Apps” in healthcare settings.  Mobile devices hold great promise for reshaping the “time and place” where an individual receives care. This study is almost complete.

The Research

Please consider forwarding this to a colleague if you thought the questions were intriguing. The research tool evaluates a number of key topics emerging in the healthcare space:

  • Opinions on the integration of apps into the Meaningful Use program
  • Characteristics important to users when downloading an app
  • Assessing desirable pricing structures

Invitation

I’d like to invite you and your ME-P readers to provide feedback on how you leverage Apps in the healthcare setting. The research instrument should take no more than 10 minutes to complete and all responses are confidential. The results may be published in a scholarly journal or industry research publication.

Respondents should be:

  • U.S. Providers, Physicians, or Nurses
  • IT Staff involved in Health IT and mobile decisions

If you have any questions, please do not hesitate to contact Thomas Martin (PI) at trm@Udel.edu,tmartin@himss.org or 412 992 1285.

personal-phone

Assessment

the research

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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On Childhood Life Insurance Policies

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A “Gift’ from Loving Parents?

By Rick Kahler CFP® www.KahlerFinancial.com

Rick Kahler CFPWhen Susan came into the world in 1974, of course her physician parents wanted the best for her. At that time, one of the loving things many parents did for their children was to purchase life insurance policies on them.

The Reasons

Parents had two reasons for these policies. The first was to pay for the funeral if a child were to die prematurely. The second was to build a little nest egg that the child might use later in life for college or a down payment on a home.

Growing Up

When Susan was six months old, her parents bought a $2,500 whole life policy on her. That amount would actually have purchased two funerals in 1974. The premium was $38 a year. If we adjust these numbers for inflation, they are comparable to a current policy with a death benefit of $12,000 and an annual premium of about $180.

Agent Explanation

The insurance agent explained they could purchase term insurance on Susan for $12 a year, but this would not accumulate anything to help Susan with a down payment on a home or college tuition.

For an additional investment of $26 a year, Susan’s policy would grow and accumulate dividends, giving her the cash she would need for that down payment.

Letting it “Grow”

Susan never did tap her policy for college or her first home. Instead she let it grow and accumulate, doing nothing but toss her annual statements into a file folder. Even so, Susan’s parents dutifully paid the premiums every year.

Today

This year, Susan became curious about her policy and dug out her most recent annual statement. She learned that if she died today her death benefit would be $2,945.90. This was the original $2,500 face value of the policy, plus dividends of $445.90 that had accumulated over 39 years. If she wanted to cancel the policy, the company would send her a check for the “surrender value” of $1,120.45.

Crunching Numbers

Susan grabbed a calculator and figured that the total premiums paid were $1,482. At first glance it would appear the policy may not have been a great investment, since the cash value in the policy was less than the sum of the payments.

But, to make a fair comparison, she needed to subtract the cost of providing the insurance ($12 a year, or a total of $468) from the total premiums. Only $26 a year, or a total of $1014, had gone toward accumulating the cash value. It was actually the $1,014 that grew to $1,120.45, which represented an annual return of about 0.25%.

Life Insurance Policy

Alternatives

Susan was curious what the $26 a year might have grown to if her parents had purchased only the term insurance and invested the difference in a stock mutual fund. She did some research and found there was a reasonable chance stocks might have returned 8% annually, meaning she would have $6,212 today. That would make a down payment on a small house and might pay for one semester of tuition at a state school. The death benefit of almost $3,000 from the term life policy would pay about half the cost of a proper funeral.

Assessment

Susan realized cancelling the policy and adding the money to her savings or investment portfolio would be the best financial decision. She was surprised at how difficult it was to carry out that decision. The policy had “always been there.” Cancelling it felt like rejecting a loving gift from her parents, especially since her father had died a few years earlier. The policy was part of her security. Giving it up was an emotional as well as a financial decision.

Susan said, “It was like saying goodbye to an old friend.”

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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An Open Call for ME-P Support

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A Letter with Advanced Appreciation

By Ann Miller RN MHA [Executive-Director]

MarcinkoAdvisors@msn.com

Dear ME-P Readers,

As the holidays approach and the year winds down, we’re reminded of how much each of you brings to the ME-P and our work.

We couldn’t do what we do so effectively without the subscribers to our daily news and book purchasers, the comments on our stories, the participants in our groups – the people who not only read our ME-P posts, but think about them, talk about it with friends and colleagues, support and push for change based on what they read.

Donate

We hope you agree that we’ve worked hard this year to deliver on our mission. It’s been a year in which we didn’t hesitate to take on the biggest subjects from the NSA ObamaCare encryption mess to Medicare Part D, from the HIEs to the latest abuses by the CFP-BOD on fiduciary terms, advisor payment definitions and conflicts of CEU interest.

If you value this work, I hope we can count on you to show your support at this season by becoming a ME-P subscriber, reader and donor.

gift

Assessment

With many thanks and best wishes for the holidays.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Symptoms prior to Out-of-Hospital cardiac arrests

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Of those with symptoms

By www.MCOL.com

Cardiac arrests

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Pennsylvania dental patients’ stolen social security numbers posted online

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EDR Data breach in Williamsport, Pennsylvania

By D. Kellus Pruitt DDS

1-darrellpruittOver the last 7 years, I have absorbed a surprising amount of criticism for warning my community that electronic dental records continue to grow both more expensive and more dangerous than paper dental records. That chunk of bad news which not one dental leader is ready to acknowledge is becoming increasingly difficult for even the most popular practice management consultants and other 3rd parties to hide. Unresponsiveness from those who profit from EDR sales is unethical and has already harmed dental patients.

Vulnerability Notes

In the Vulnerability Notes that have been issued by the US Department of Homeland Security to dental software giant Dentrix in the last year, security expert Justin Shafer was thanked in both for alerting authorities to Dentrix’s weaknesses.

Though evasive EDR stakeholders were able to fend off transparency far too long, it is fast becoming obvious to the world that their free ride with no accountability has always been destined to end ugly, and greed is to blame. Unforgiving media coverage of the nation’s loss of confidence in EDRs just might start in day or so in the parking lot of dentist’s office near Williamsport, Pennsylvania. Take cover, Dentrix

Eyeing Dentrix 

In the last two years, Justin Shafer’s uninvited watchful eye over Dentrix’s vulnerabilities may have already helped protect millions of dental patients from identity theft. Nevertheless, Dentrix’s security problems which company officials apparently hide, continue to endanger the welfare of uninformed Americans. I have learned that Shafer doesn’t give up easily. He’s in HIT for the long haul.

Yesterday morning, he posted a heads-up on the City of Williamsport’s Facebook, as well four other local Facebooks, warning of the results of a dental office data breach of Dentrix software: Dental patients’ social security numbers have become available on a zip file from Piratebay.

Shafer: “I am willing to bet there are a lot of your citizens SSN’s in this database. Look at rsc_dat.dat and patient.dat… Seems a dental database ended up on piratebay. You may already know.. you may not.”

He explained it to me this way: “the practice info is in rsc_dat.dat, patient info is in pat_dat.dat. It’s a nightmare, and I told dentrix and the doctor a full year ago.”

Insightful or clueless dentist?

Assessment 

Did your opinion of censorship in dental care recently undergo change?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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An ME-P Thanksgiving Day 2013 Tribute

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A Letter from the Publisher-in-Chief

By Dr. David E. Marcinko; MBA, CMP™

Washington, DC: “I do therefore invite my fellow citizens … to set apart … a day of thanksgiving and praise to our beneficent father who dwelleth in the heavens.”

— Abraham Lincoln

Dear ME-P Readers & Subscribers

These words were spoken in the middle of Lincoln’s Thanksgiving Proclamation on Oct. 3, 1863 while the country waged a horrific civil war. In light of the political and macro-economic challenges we’ve been confronting in our country today, and the accompanying rancor in the healthcare industrial complex, this is the perfect time to revisit those wise and carefully chosen words.

Thanksgiving Proclamation

And so, I’ve included Lincoln’s Thanksgiving Proclamation in its entirety below. From my way of thinking, it should be required reading by every American every Thanksgiving. In particular, our target market of medical professionals and financial advisors should reflect on the lifestyle opportunities afforded to those who work hard, work smart, and who work to serve their patients and clients in a fiduciary capacity.

October 3, 1863

The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God. In the midst of a civil war of unequaled magnitude and severity, which has sometimes seemed to foreign States to invite and to provoke their aggression, peace has been preserved with all nations, order has been maintained, the laws have been respected and obeyed, and harmony has prevailed everywhere except in the theatre of military conflict; while that theatre has been greatly contracted by the advancing armies and navies of the Union. Needful diversions of wealth and of strength from the fields of peaceful industry to the national defense, have not arrested the plough, the shuttle or the ship; the axe has enlarged the borders of our settlements, and the mines, as well of iron and coal as of the precious metals, have yielded even more abundantly than heretofore. Population has steadily increased, notwithstanding the waste that has been made in the camp, the siege and the battle-field; and the country, rejoicing in the consciousness of augmented strength and vigor, is permitted to expect continuance of years with large increase of freedom. No human counsel hath devised nor hath any mortal hand worked out these great things. They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy. It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People. I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens. And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquility and Union. In testimony whereof; I have hereunto and caused the seal of the United States to be affixed.

Blessed to be Americans

We are blessed and thankful to be Americans. And yes, we are blessed to be living in a country that has afforded so many wonderful opportunities; like publishing this ME-P.

That said, I think it is important to revisit the birthing of our beloved Thanksgiving holiday. If only we had Lincoln’s leadership and greatness to help us through our challenges of today.

But, if Father Abe was alive and editing this ME-P, he’d likely tell you a story, send in a post or comment, share a humorous but poignant anecdote, interject his kindness, and/or tell you to take advantage of the opportunities of today, both in healthcare and personal financial planning for medical professionals.

IOW: Engage, contribute and opine on our ME-P platform to the fullest extent possible. Promote it and hold us accountable.

Our Thanks to You

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On behalf of our ME-P staff, we want to thank all of you who have e-mailed and subscribed to us. We will continue to do our best to answer each letter and strive to make your subscription more worthwhile than ever before.

Assessment

If you have any topic suggestions or special requests, please contact us at: MarcinkoAdvisors@msn.com

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Should HHS Secretary Kathleen Sebelius be Replaced?

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A Voting and Opinion Poll

[By Ann Miller RN MHA]

We are all aware that critics are calling for the head of Kathleen Sebelius after the clumsy online rollout of the PP-ACA.

And so, we ask:

Assessment

After you vote; please leave a cogent opinion, too.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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Understanding NYSE / NASD Minimum Credit Requirements

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A Primer for Physician Investors and Medical Professionals

By: Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

[PART 8 OF 8]

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

We have seen that there are rules which stipulate that no brokerage firm may arrange for any credit to any client whose margin account does not have an equity of at least $2,000. The principal application of this rule is to initial transactions in newly opened margin accounts, however, it does apply at all times. 

Example: A doctor buys 100 shares, at $15, in a new margin account. His margin call is $1,500.

Rationale: $2,000 would be too much to require as it exceeds the total purchase price. However, a loan to the doctor isn’t allowed to be extended until, and unless, the account has equity of $2,000. The trade is simply paid in full -100% of the purchase price is the margin call. 

Example: A doctor buys 200 shares, at $15, in a new margin account (assume Regulation T = 60%).

His margin call is $2,000 

Rational: Regulation T 60% would be $1,800 (60% x $3,000). Since this would be $200 shy of the minimum equity level of $2,000, the call is the $2,000 minimum equity. 

Example: A doctor buys 300 shares, at $15, in a new margin account. (assume Regulation T = 60%) His margin call is $2, 700. 

Rationale: The account will have equity of $2, 700 (60% x $4,500), which is more than the $2,000 minimum. Therefore, the Regulation T initial requirement prevails.

The important points to remember about minimum credit requirements are:

1. You are not called upon to pay more than the purchase price.

2. You cannot be granted a loan until the account has an equity of at least $2,000.

3. If a decline in the market value of an existing account puts the equity below $2,000, there is no requirement to bring the equity back up to $2,000.

4. You may not withdraw money or securities from the account, if in doing so, you either:

  1. bring the equity below $ 2,000, or
  2. bring the equity below the maintenance level

These are the only times SMA may not be withdrawn from an account

The Short Sale

Selling short is engaged in by medical professionals who anticipate a market decline. By selling borrowed property (shares of stock) at the current market value, the doctor expects to return the borrowed property (shares of the same issuer bought in the marketplace) to the lender, normally the investor’s brokerage firm, when the market price is lower, thus profiting from the drop in price.

Essentially this is the buy low, and sell high philosophy. However, when executing a short sale one is selling high initially, then buying low later to “cover”, or close out the deal by buying low and selling high in the reverse order .

Bear in mind that the short seller is borrowing property, not money. However, due to the high degree of risk inherent in short selling, it is permitted only in a margin account. A Regulation T call is required as a show of good faith, a way the client demonstrates the financial wherewithal to buy back the property. Let’s look at a short sale transaction and the subsequent effects of market fluctuations on equity, as we did previously with buying on margin (long margin).

Credit Balance and Equity

A doctor shorts (sells short) 100 shares at $100 per share with Regulation T at 60%. The margin account would be credited with the proceeds of the sale, though the doctor has no access to these monies at this point in the deal. The account should also be credited with the doctor’s required Regulation T margin call. Therefore, the credit balance in a doctor’s margin account is the sum of the  proceeds of the short sale, plus the Regulation T margin call. This number will not change, regardless of future market fluctuations. The credit balance in a short margin account is a constant.

What does change with market fluctuations?

  1. the cost of buying back the borrowed property to cover the short sale.
  2. the equity in the account.

Equity in a short margin account is computed as follows:

Credit of  $ 16,000 – CMV  $10,000 equals $ 6,000 equity.

Now, let’s evaluate the effect of appreciation in the market price

If the stock rises to $120 per share, then the credit of $16,000 – CMV $ 2, 000, equals $ 4,000 equity.

Remember, the credit balance does not change when CMV fluctuates. The equity in this account is no longer Regulation T.

Let’s determine the amount by which the account is restricted (remember, any margin account with equity below Regulation T is restricted). Or, 60% X $12,000 = $ 7,200 – $ 4,000 = $ 3,200

Also, it should be clear, the equity percentage of this account is less than 60%, by the formula:

Equity / CMV = $ 4,000/$ 12,000 = 33.33%

This is the basic principle of the short sale; as the market price of the shorted stock increases, the equity decreases. The reverse is also true; as the price declines, the equity rises. Remember, short sellers are anticipating a market decline. Also, when buying long, or selling short, any change in market value causes a dollar for dollar change in equity.

Minimum Maintenance Requirements (Short) 

If the market continues to appreciate to $160 per share, the equity drops to zero.

Suppose that the market price rose to its theoretical maximum, or infinity? The doctor’s loss would be infinite. Remember, the maximum potential loss on a short sale is unlimited!

To protect against such an occurrence, industry Self Regulatory Organizations (SROs) developed regarding the minimum equity that must be maintained in a margin account. The minimum maintenance in a short account is equity of 30% of CMV. Note that this is higher than the 25 % figure for long margin accounts due to the nature of extreme risk of loss in the short sale.

Given that the CMV has risen to $160 per share ($16,000 total CMV), the minimum equity required to be maintained under SRO rules is 30% x CMV or  $4,800 equity. The doctor would receive a $4,800 maintenance call to bring his equity from -0- to the $4,800 minimum.

Remember, as in (cash) long accounts, there is no requirement to bring a margin account up to Regulation T equity. The maintenance equity is the percentage up to which the account must be brought when and if equity drops below the 25% or 30% levels.

Excess Equity (SMA) and Buying Power

We have seen what market appreciation does to a short seller. Let’s evaluate the effects of market depreciation in value. If the declines to $85, per share, then $ 16,000 credit – CMV $ 8,500 = $ 7,500 equity. Again, market fluctuations don’t affect credit balance. The equity in the account is now higher than Regulation T, and SMA (excess equity) has just been created.

And, as before, excess equity (SMA) can be used to buy more securities. Couldn’t it also be used as the Regulation T down payment on another sale? Yes, this is another use of SMA that is called shorting power or “selling power”. The formula for buying power as well as shorting power is exactly the same: Remember, it’s SMA / RT to use buying power.

In this case, $2,400 / 60% = $4,000 of buying (shorting) power after the decline to $85, the doctor could buy long or sell short another $4,000 worth of stock and use his SMA to meet his 60% ($2,400) Regulation T Margin call. Recall, the margin call for a short sale is the same as for a long purchase.

Cheap Stock Rule

The SROs created a set of special maintenance rules in short margin accounts to protect against unreasonable risk in low-priced issues. These rules are appropriately labeled the “cheap stock” rules.

At all times, a doctor must maintain equity in a short margin account of the greater of the following:

  1. 30% of the CMV (SRO Minimum Maintenance Requirement)
  2. $2,000 (SRO Minimum Credit Requirement)

3.   Equity as required under the rules  below

The cheap stock rules are as follows:

Stock Price                                     Minimum Maintained Equity

0 – $2.50 per share             $ 2.50 per share

$2.50 – $5.00 per share      100% of per share price

$5.00 per share and up       $ 5.00 per share

Example: A doctor shorts 1,000 shares of a $1.50 per share stock. How much must he deposit initially and how much must be maintained in the account?

First, since Regulation T won’t come into play until equity hits $2,000, the SRO minimum credit requirement of $2,000 should come into play. However, since this is a cheap stock, we determine if the requirements of those special rules require more than $2,000. They do, and require a minimum be maintained in this short margin account of at least $2.50 per share sold short (1,000 shares at $2.50 each = $2,500 minimum that needs to be in this account at all times to comply with SRO rules).

Furthermore, if the market begins to rise, the cheap stock rules would require that at all times the amount of money in the account be at least 100% of the price per share until the stock hits $5. For example, if the stock rose to $4 per share, the doctor would have to have $4,000 in the account to carry the position (1,000 shares times 100% of CMV, $4 per share in this case).

Day Trading and the Internet

Internet day trading has become something of an, investment bubble of late, suggesting that something lighter than air can pop and disappear in an instant. This has occurred despite the fact that most lay and healthcare professionals who engage in such activities, do not appreciated even the basic rules of margin and debt, as reviewed review. History is filled with examples: from the tulip mania of 1630 Holland and the British South Sea Bubble of the 1700’s; to the Florida land boom of the roaring twenties and the Great Crash of 1929; and to $ 875 an ounce gold in the eighties and to the collapse of Japans stock and real estate market in  early 1990’s. To this list, one might now add day Internet trading

The cost of compulsive gambling, arising from internet day trading activities, may be high for the physician, his family and society at large. Compulsive gamblers, in the desperation phase of their gambling, exhibit high suicide ideation, as in the case of Mark O Barton’s the murderous day-trader in Atlanta. His idea actually became a final act of desperation. Less dramatically is a marked increase in subtle illegal activity. These acts include fraud, embezzlement, CPT up-coding, medical over utilization, excessive full risk HMO contracting, and other “alleged white collar crimes.”  Higher healthcare and social costs in police, judiciary (civil and criminal) and corrections result because of compulsive gambling. The impact on family members is devastating. Compulsive gamblers cause havoc and pain to all family members. The spouses and other family members also go through progressive deterioration in their lives. In this desperation phase, dysfunctional families are left with a legacy of anger, resentment, isolation and in many instances, outright hate.

Recent Updates

Since most people, including medical professions,  initially loose at day trading, they give up and decide not to do it anymore. As there is a minimum amount of money, about $ 25,000-50,000 of trading capital needed to start, this loss is a powerful de-motivator. Still, scared by the Barton incident, the NASD and NYSE have recently proposed new rules for those who engage in questionable day trading activities.  One proposal would provide that a minimum equity of $ 25,000 be maintained at all times, versus the current $ 2,000 for other margin accounts. If the amount of a pattern day trader fell below the new threshold, no further trading would be permitted until the threshold was maintained.

Options Trading

Stock options are contracts that obligate medical investors to either buy or sell a stock at a specific price, by a specific date. For example, a put option is a bet on falling prices. Let’s suppose Dr. Jane Smith holds a put option on XYZ stock, with a $ 50 exercise price, and the stock falls to $ 45. The value of the put rises in the options market because it lets her sell a $ 50 share, which is above the market price. A call option, on the other hand, is a bet on rising prices. Again, Dr. Smith holds a call option on XYZ stock, with an exercise price of $ 50. If the share rises to $ 55, the value of the option increase since she may buy for $ 50, a stock now worth $ 55.

In 1999, Charles Schwab, the biggest on-line brokerage executed more than 30 million option trades. Due to this demand, Schwab launched other complex services, such as the on-line simultaneous buying and selling of options. Also crowding the options field, are new upstart on-line brokerages, such as: Interactive Brokers, Preferred Capital Markets Technology and CyberCorp. They provide powerful software which will allow options in the future to trade as effortlessly and efficiently as stocks.

In  mid-2000 the Reuters Group PLC Instinet Corporation, the electronic network most widely used by institutional investors, opened an Internet brokerage aimed at consumers, including healthcare practitioners. Instinet will let retail clients place orders alongside institutions, and will offer access to charts, news and research. Thus, artificially empowering the individual investor, as well as again tempting the compulsive prone addict.

Acknowledgements

The assistance Mr. James Nash, of the Investment Training Institute, in Tucker, GA is acknowledged in the preparation of this ME-P.

Conclusion

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Web Sites of Interest

http://www.tradehard.com

The ultimate super site for investment bankers and traders. Started by a group of well known stockbrokers, day traders, and money managers. This site offers advice about how to work the market to your advantage.

http://www.internetinvesting.com

This is an investor’s guide to on-line brokers, discount brokers, day trading and after hours investing. The site offers stock quotes, financial news, investment banking strategies, a book list and daily commentary about the market. This is a serious text heavy resource.

References and Readings

  • Atkinson,  W., and Crawford, AJ.:  On-line investing raises questions about suitability. Wall Street Journal, November, 28, 1999.
  • Farrell, C.: Day Trade On-line. John Wiley & Sons, New York, 1999.
  • Friedfertig, M.: Electronic Day Trader’s Secretes. McGraw-Hill, New York, 1999.
  • Gibowicz, Peter: Registered Representative (Study Program ,Volume II). Edward Fleur Financial Education Corporation, New York, 1998.
  • Gibowicz, Peter: Quick Seven. Edward Fleur Financial Education Corporation, New York, 1998.
  • Gibowicz, Peter: Registered Representative (Study Program, Volume I). Edward Fleur Financial Education Corporation, New York, 1998.
  • Kadlec, CW.: Dow 100,000: Fact or Fiction. New York Institute of Finance, New York, 1999
  • Nash, J: Securities Markets. In, Nash, J: (International Training Institute Manual). Atlanta, 1999.
  • Nassar, DS: How to Get Started in Electronic Day Trading. McGraw-Hill, New York,
  • 1999.
  • Schmuckler, E:  The Addictive Personality. In, Marcinko, DE (2001 Financial Planning for Medical Professionals. Harcourt Professional Publishing, New York, 2000. 

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Percentages of Patients Experiencing Cost-Related Healthcare Access Problems

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An Infographic by Country

By www.MCOL.com

dem

Assessment

Now, compare this to healthcare access difficulties in the USA.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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How to Succeed as an “Active-Passive” Investor [Part II]

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An Oxymoron—Part Two

By Rick Kahler CFP® http://www.KahlerFinancial.com

Rick Kahler CFPContinued from last week, here are the remaining keys to help fine-tune your core passive investment strategy for optimum success.

5. Asset allocation.

This is critical. Study after study shows the most important determinate in your overall investment success isn’t picking the right stocks, bonds, or real estate. According to one researcher, a good asset allocation strategy can add about 0.5% to your long-term return. It’s your overall mix of various asset classes that will ultimately have the greatest impact on your success or failure. Investing your entire 401(k) in several stock index funds can be as insane as putting everything into bond funds. Even a mix of stocks and bonds, while better, can leave a portfolio over-exposed to the fortunes of one sector and exposed to the failing of one country’s economy.

6. Manager and index selection.

Especially if you are over 40 and have retirement in sight, successful passive investing isn’t quite as easy as calling Vanguard and putting everything in an S&P 500 index fund. Every asset class has multiple indexes, with managers who all have their differences in philosophy, execution, and fees. Some adhere to traditional indexes while others build their own indexes based on their research. Picking the right index with the right manager can add up to 2% over the long haul to the annual return generated by a good asset allocation.

7. Rebalancing.

Once you set your target allocations, you need to periodically sell off the advancing asset classes to purchase more of the lagging classes. Suppose you want 30% of your portfolio in U.S. stocks and 30% in bonds. If stocks are doing well and bonds are not, over time you might end up with 35% stocks and 25% bonds. Selling stocks and buying bonds to rebalance the allocations is a disciplined form of “buy low and sell high.” Without it, your portfolio will miss out on some extra returns and over time take on more risk and volatility. Research shows that periodic rebalancing can add 0.5% to 1.5% annually over the long term.

8. Asset placement and taxes.

Other adjustments need ongoing attention in any portfolio. Asset class location helps minimize tax consequences by matching the assets with the right account. IRA’s are best for certain asset classes, while Roth IRA’s do best with others and taxable accounts with still others. This matching can add up to 0.5% annually, so getting it right can be a big deal. It’s also important to tweak asset class allocations to adjust for long-term bear or bull markets, significant economic or tax policy changes, or changing personal situations. Another necessity is minimizing taxes by efficient and timely loss and gain harvesting.

9. Uncovering scams and ill-suited investments.

Recently a client asked me about a start-up online business in which several of her friends had invested. While there were many things about it that concerned me, at the core this just wasn’t an investment opportunity that suited my client’s expertise, goals, or risk tolerance. I strongly urged her to pass, and she did. Within six months the offering was found to be a well-pitched scam, and everyone who invested lost their money. Having someone to help investigate the legitimacy of investment ideas can always be helpful.

10. Keeping it sensibly simple.

Keeping things simple for simplicity’s sake doesn’t always produce the desired benefits. While it’s simple to put your whole portfolio into one stock or one mutual fund, the results could end up adding layers of complexity to your life. The right amount of sensible complexity can turn a good passive investing strategy into a highly successful one. 

MD

Assessment

How to Succeed as an “Active-Passive” Investor [Part I]

Conclusion

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Why Physician-Investors Must Understand TAMPs

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Third Party Outsourcing of Your Investments

By Dr. David Edward Marcinko MBA CMP™

Dr David E Marcinko MBATurnkey Asset Management Programs (TAMPs) allow independent financial advisors [FAs], Registered Investment Advisors [RIAs] – typically fiduciaries – to outsource the management of some or all of their clients’ assets.

More recently, Certified Public Accountants, law firms and banks also are using them to enter the financial advice marketplace

Managed Account Services

With a TAMP, financial advisors gain access to managed account services that allow them to offload time-consuming functions, such as research, portfolio construction, rebalancing, reconciliation, performance reporting, and tax optimization and reporting, which allows them to focus on clients’ personal financial needs, marketing, advertising and sales concerns

Fee-Based Accounts

TAMPs are a form of fee-account, which charge fees based on a percentage of the total assets managed in the program. TAMPs appeal to independent financial advisors who are building a fee-only business, because they can avoid the cost of building their own fee-accounts platform and can implement a TAMP in about 90 days, instead of the year or longer required to develop the same capabilities in-house.

TAMPs also help independent advisors avoid employee hiring and payroll costs related to internal administration and research, which for a modest program requiring a staff of 8-10 employees can typically cost $1 million per year in ongoing overhead. Because TAMPs serve financial advisors, individual retail investors are not able to directly invest their assets in a TAMP.

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TAMPs

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“Meet and Greet” Meetings

So, the next time your FA has a quarterly meeting with you to discuss the status of your investment account or retirement portfolio, just realize that s/he is usually only the middleman. S/he is not buying, selling or trading stocks for you. An “anonymous omniscient other” behemoth firm is actually doing the work and merely placing your name on a glossy automated printed report. Your FA passes the report along as his/her alone, complete with his/her name and firm embossed, therein.  Usually with a supplication like this.

The courtesy of your referral is our only reward.

And, the day of your quarterly meeting, in his/her fancy office, is probably the first and only day the report is even reviewed by the FA. This is why most of the FAs time is spent prospecting, or in marketing, advertising and/or other sales activities.  All the heavy-lifting is done elsewhere.

In the industry, this type of Financial Advisor is known as an asset aggregator. And, in the retail sector, most FAs are asset aggregators or gatherers.

http://en.wikipedia.org/wiki/Turnkey_Asset_Management_Program

Number Crunching

Now, let’s say you have one millions dollars to invest and the FA charges you one percent of your AUMs; annually. This is common in the industry with ranges up to 3%, or so. Yep; that’s ten grand out of your pocket.

The Financial Advisor thus receives about $5,000/per year and the TAMP gets the same; year after year. This is reduced to $2,500 or so, to the FA, after office overhead costs. It does not matter if the market, or your account, is up or down. Such the deal!

Nevertheless, the money is automatically flowing away from you much like an annuity; or cash cow. Since you do not actually write a check out to the FA or firm, you may forget about the fees. Get the idea!

Therefore, a firm with $100 million dollars in AUMs earns about: $1-M X 50% = $500,000/year. With scale-ability, it is easy to see how Wall Street has all those skyscrapers in Manhattan, Chicago, London or Tokyo. AUM fees go up drastically, with little increase in overhead. Remember the economic concepts of marginal revenues and marginal costs!

In the industry, we call this Recurring Income. RI is preferred over a one time stock-broker commission [one-time sale] because it’s producing revenue for the TAMP and FA 24/7/365.

To be sure, it is difficult for FAs to obtain such clients; but once in the fold, clients are loathe to leave.

Assessment

Is it a wonder why big firms and wire-houses [brokerages] place their employee FAs under non-compete clauses? In other words, you the client, are owned by the company. You are not a client of the individual FA. So, when an FA leaves or retires, your account stays with the firm unless you transfer it. Expect to receive a very hard sell to stay, when you threaten to leave.

More:

Conclusion

Now, you know why sales skills are needed – over financial acumen – in this business. A great personality trumps education and brain power, most every time.

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Even More 2013 Year End Tax Planning Tips for Physicians

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Last Minute Considerations for Medical Professionals … and Us All

By Robert Whirley CPA

2500-190 North Winds Parkway

Alpharetta GA 30009-2245

Dear ME-P Readers:

Year-end tax planning could be especially productive this year because timely action could nail down a host of tax breaks that won’t be around next year unless Congress acts to extend them, which, at the present time, looks doubtful. I have tried to keep this brief but, as typical, the changes this year are voluminous.

High-Income Earners

High-income-earners have other factors to keep in mind when mapping out year-end plans. For the first time, they have to take into account the 3.8% surtax on unearned income and the additional 0.9% Medicare (hospital insurance, or HI) tax that applies to individuals receiving wages with respect to employment in excess of $200,000 ($250,000 for married couples filing jointly and $125,000 for married couples filing separately).

Medicare Tax

The additional Medicare tax may require year-end actions. Employers must withhold the additional Medicare tax from wages in excess of $200,000 regardless of filing status or other income. Self-employed persons must take it into account in figuring estimate tax. There could be situations where an employee may need to have more withheld toward year end to cover the tax.

For example, an individual earns $200,000 from one employer during the first half of the year and a like amount from another employer during the balance of the year. He would owe the additional Medicare tax, but there would be no withholding by either employer for the additional Medicare tax since wages from each employer don’t exceed $200,000.

Also, in determining whether they may need to make adjustments to avoid a penalty for underpayment of estimated tax, individuals also should be mindful that the additional Medicare tax may be over-withheld. This could occur, for example, where only one of two married spouses works and reaches the threshold for the employer to withhold, but the couple’s income won’t be high enough to actually cause the tax to be owed.

Checklist

I have compiled a checklist of additional actions based on current tax rules that may help you save tax dollars if you act before year-end. Not all actions will apply in your particular situation, but you will likely benefit from many of them.

Tax

[Year-End Tax Planning Moves for Individuals]

• Increase the amount you set aside for next year in your employer’s health flexible spending account (FSA) if you set aside too little for this year.

• If you become eligible to make health savings account (HSA) contributions in December of this year, you can make a full year’s worth of deductible HSA contributions for 2013.

• Realize losses on stock while substantially preserving your investment position. There are several ways this can be done. For example, you can sell the original holding, then buy back the same securities at least 31 days later. It may be advisable for us to meet to discuss year-end trades you should consider making.

• Postpone income until 2014 and accelerate deductions into 2013 to lower your 2013 tax bill. This strategy may enable you to claim larger deductions, credits, and other tax breaks for 2013 that are phased out over varying levels of adjusted gross income (AGI). These include child tax credits, higher education tax credits, the above-the-line deduction for higher-education expenses, and deductions for student loan interest. Postponing income also is desirable for those taxpayers who anticipate being in a lower tax bracket next year due to changed financial circumstances. Note, however, that in some cases, it may pay to actually accelerate income into 2013. For example, this may be the case where a person’s marginal tax rate is much lower this year than it will be next year or where lower income in 2014 will result in a higher tax credit for an individual who plans to purchase health insurance on a health exchange and is eligible for a premium assistance credit.

• If you believe a Roth IRA is better than a traditional IRA, and want to remain in the market for the long term, consider converting traditional-IRA money invested in beaten-down stocks (or mutual funds) into a Roth IRA if eligible to do so. Keep in mind, however, that such a conversion will increase your adjusted gross income for 2013.

• If you converted assets in a traditional IRA to a Roth IRA earlier in the year, the assets in the Roth IRA account may have declined in value, and if you leave things as-is, you will wind up paying a higher tax than is necessary. You can back out of the transaction by recharacterizing the rollover or conversion, that is, by transferring the converted amount (plus earnings, or minus losses) from the Roth IRA back to a traditional IRA via a trustee-to-trustee transfer. You can later reconvert to a Roth IRA.

• It may be advantageous to try to arrange with your employer to defer a bonus that may be coming your way until 2014.

• Consider using a credit card to prepay expenses that can generate deductions for this year.

• If you expect to owe state and local income taxes when you file your return next year, consider asking your employer to increase withholding of state and local taxes (or pay estimated tax payments of state and local taxes) before year-end to pull the deduction of those taxes into 2013 if doing so won’t create an alternative minimum tax (AMT) problem.

• Take an eligible rollover distribution from a qualified retirement plan before the end of 2013 if you are facing a penalty for underpayment of estimated tax and the increased withholding option is unavailable or won’t sufficiently address the problem. Income tax will be withheld from the distribution and will be applied toward the taxes owed for 2013. You can then timely roll over the gross amount of the distribution, as increased by the amount of withheld tax, to a traditional IRA. No part of the distribution will be includible in income for 2013, but the withheld tax will be applied pro rata over the full 2013 tax year to reduce previous underpayments of estimated tax.

• Estimate the effect of any year-end planning moves on the alternative minimum tax (AMT) for 2013, keeping in mind that many tax breaks allowed for purposes of calculating regular taxes are disallowed for AMT purposes. These include the deduction for state property taxes on your residence, state income taxes (or state sales tax if you elect this deduction option), miscellaneous itemized deductions, and personal exemption deductions. Other deductions, such as for medical expenses, are calculated in a more restrictive way for AMT purposes than for regular tax purposes in the case of a taxpayer who is over age 65 or whose spouse is over age 65 as of the close of the tax year. As a result, in some cases, deductions should not be accelerated.

• Accelerate big ticket purchases into 2013 in order to assure a deduction for sales taxes on the purchases if you will elect to claim a state and local general sales tax deduction instead of a state and local income tax deduction. Unless Congress acts, this election won’t be available after 2013.

• You may be able to save taxes this year and next by applying a bunching strategy to “miscellaneous” itemized deductions, medical expenses and other itemized deductions.

• If you are a homeowner, make energy saving improvements to the residence, such as putting in extra insulation or installing energy saving windows, or an energy efficient heater or air conditioner. You may qualify for a tax credit if the assets are installed in your home before 2014.

• Unless Congress extends it, the up-to-$4,000 above-the-line deduction for qualified higher education expenses will not be available after 2013. Thus, consider prepaying eligible expenses if doing so will increase your deduction for qualified higher education expenses. Generally, the deduction is allowed for qualified education expenses paid in 2013 in connection with enrollment at an institution of higher education during 2013 or for an academic period beginning in 2013 or in the first 3 months of 2014.

• You may want to pay contested taxes to be able to deduct them this year while continuing to contest them next year.

• You may want to settle an insurance or damage claim in order to maximize your casualty loss deduction this year.

• If you are age 70-1/2 or older, own IRAs and are thinking of making a charitable gift, consider arranging for the gift to be made directly by the IRA trustee. Such a transfer, if made before year-end, can achieve important tax savings.

• Take required minimum distributions (RMDs) from your IRA or 401(k) plan (or other employer-sponsored retired plan) if you have reached age 70-1/2. Failure to take a required withdrawal can result in a penalty of 50% of the amount of the RMD not withdrawn. If you turned age 70-1/2 in 2013, you can delay the first required distribution to 2013, but if you do, you will have to take a double distribution in 2014-the amount required for 2013 plus the amount required for 2014. Think twice before delaying 2013 distributions to 2014-bunching income into 2014 might push you into a higher tax bracket or have a detrimental impact on various income tax deductions that are reduced at higher income levels. However, it could be beneficial to take both distributions in 2014 if you will be in a substantially lower bracket that year, for example, because you plan to retire late this year.

• Make gifts sheltered by the annual gift tax exclusion before the end of the year and thereby save gift and estate taxes. You can give $14,000 in 2013 to each of an unlimited number of individuals but you can’t carry over unused exclusions from one year to the next. The transfers also may save family income taxes where income-earning property is given to family members in lower income tax brackets who are not subject to the kiddie tax.

US capitol

[Year-End Tax-Planning Moves for Businesses & Business Owners]

• Businesses should consider making expenditures that qualify for the business property expensing option. For tax years beginning in 2013, the expensing limit is $500,000 and the investment ceiling limit is $2,000,000. And a limited amount of expensing may be claimed for qualified real property. However, unless Congress changes the rules, for tax years beginning in 2014, the dollar limit will drop to $25,000, the beginning-of-phaseout amount will drop to $200,000, and expensing won’t be available for qualified real property. The generous dollar ceilings that apply this year mean that many small and medium sized businesses that make timely purchases will be able to currently deduct most if not all their outlays for machinery and equipment. What’s more, the expensing deduction is not prorated for the time that the asset is in service during the year. This opens up significant year-end planning opportunities.

• Businesses also should consider making expenditures that qualify for 50% bonus first year depreciation if bought and placed in service this year. This bonus writeoff generally won’t be available next year unless Congress acts to extend it. Thus, enterprises planning to purchase new depreciable property this year or the next should try to accelerate their buying plans, if doing so makes sound business sense.

• Nail down a work opportunity tax credit (WOTC) by hiring qualifying workers (such as certain veterans) before the end of 2013. Under current law, the WOTC won’t be available for workers hired after this year.

• Make qualified research expenses before the end of 2013 to claim a research credit, which won’t be available for post-2013 expenditures unless Congress extends the credit.

• If you are self-employed and haven’t done so yet, set up a self-employed retirement plan.

• Depending on your particular situation, you may also want to consider deferring a debt-cancellation event until 2014, and disposing of a passive activity to allow you to deduct suspended losses.

• If you own an interest in a partnership or S corporation you may need to increase your basis in the entity so you can deduct a loss from it for this year.

Assessment

These are just some of the year-end steps that can be taken to save taxes.

Conclusion

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The Price of Pleasure

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Sin Taxes

By Carrie Braza

Sin-taxes

More

Conclusion

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Is HEALTHCARE.GOV Fundamentally Flawed?

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You Decide

By Ayo Fathiah

Hello Dr. David Edward Marcinko,

My name is Ayo, I’m the mother of two beautiful kids and one of the Americans that was relying on healthcare.gov to provide me with a reasonably priced health insurance.

I came across your ME-P articles when researching what exactly has gone wrong with the website. I was one of the millions that tried to sign up during the first days after the launch and couldn’t get through due to a bunch of errors. While I’m still trying to find the best insurance for my family, I just wanted to share with you some stats showing why the website was a major flop.

***

interface

***

And, I thought it might be interesting to your readers, because I saw a many readers talking about it. Isn’t it surprising that less than 1% of people that went on the website signed up for an insurance?

HCdotGOV_final

The Website

1.) Had extremely low login success rates. 2.) Long delays and time outs 3.) Confusing Error Messages 4.) Non-functional calculators 5.) Scrambled insurance information 6.) Spouses reported as children 7.) Plan pricing misreported.

Assessment

Leading to the larger questions:

  • Will enrollment glitches become provider glitches?
  • Will people who enrolled with the glitchy show up at hospitals with no insurance?
  • Will the information of those who enrolled be at risk?

DANGER: Centralized data SSN Address Ages Names Health conditions Family History

Leads to centralized power over everyday Americans

Good: if we can make an efficient healthcare system

Bad: Governmental Abuse, and all the data an identity thief could want

But this problem runs deeper than just a website… Because the numbers just don’t add up.

Universal healthcare is important, but crony capitalism doesn’t solve anything.

Citations:

  1. http://msnbcmedia.msn.com/i/MSNBC/Sections/A_Politics/_Today_Stories_Teases/Late_October_NBC_WSJ.pdf
  2. https://blog.compete.com/2013/10/15/obamacare-enrollment-stats/
  3. http://www.nextgov.com/health/2013/10/less-1-percent-healthcaregov-visitors-successfully-enrolled-insurance-plan/72041/

Conclusion

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The PP-ACA from Medicine to Dentistry

Obamacare and Dentistry

[By D. Kellus Pruitt DDS]

1-darrellpruitt It seems that problems with the PP-ACA have migrated from traditional medicine to the world of dentistry.

“MaineCare dentists hit with massive fines for minor clerical errors, they say – Some clinics face more than $200,000 in penalties under a new audit system that threatens to wipe out services for kids.”

-Joe Lawlor [Staff writer] Portland Press Herald [November 6, 2013]

http://www.pressherald.com/news/MaineCare_dentists_hit_with_massive_fines_for_minor_clerical_errors__they_say_.html

 “The new system gives auditors, who work for a private contractor, financial incentives to find small errors by paying them more for each mistake they discover.” Maine adopted the auditing system to comply with the federal Affordable Care Act, otherwise known as Obamacare.

 Lawlor continues: “The audits are intended to root out fraud and abuse, but dentists told the Portland Press Herald that auditors are finding typographical or clerical errors that do not compromise patients’ care or defraud the government.”

A Clawback?

Dr. Michael Dowling, co-owner of Falmouth Pediatric Dentistry, tells the Herald, “This is not finding fraud and abuse. This is a clawback. They (state officials) are trying to take back money that we billed them legitimately.”

Still want to help the poor so much that you are willing to take your chances with the ACA auditing system, Doc?

Dentists facing bankruptcy

According to Lawlor, some dentists are actually facing bankruptcy because of ridiculously expensive fines over minor errors. Other Maine dentists who are otherwise willing to work for charity-level fees in order to help children who have nowhere else to turn, are dropping out of MaineCare. President Obama’s plan to use outrageous fines to fund the state and federal coffers, as well as the bonuses of ambitious auditors, is destined to fail.

How can the Affordable Care Act [PP-ACA] possibly make care more affordable for children with toothaches, if it runs off all the dentists?

Mobile-Security

Assessment

Is it beginning to look to you like Obamacare might have been designed to serve the interests of unaccountable healthcare stakeholders rather than the interests of doctors and patients – the healthcare principals? Why do we put up with this crap, Doc?

Conclusion

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How to Succeed as an “Active-Passive” Investor [Part I]

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An Oxymoron—Part One

By Rick Kahler CFP® http://www.KahlerFinancial.com

Rick Kahler CFPA fundamental principle I preach is that having a core of passively managed mutual funds is the foundation of successful long-term wealth building. I practice that principle, as well: about 75% of the securities in my personal portfolio are passively selected.

My commitment to this approach has evolved both from my own years of investing experience and from reading reams of research. I’m convinced that “beating the market” over the long term is as elusive a goal as capturing a wild jackalope.

Fundamental Strategy

Does that mean investing is as simple as giving most of your money to passive managers and kicking back? Not quite. Yes, investing in the index funds of a diversified group of asset classes and leaving them alone is a good fundamental strategy that will help you secure your financial future. To be even more successful, however, it helps to actively apply some additional strategies.

Additional Strategies

I was reminded of this by a June 2013 blog post from Bob Seawright of Madison Avenue Securities. Here, inspired by and adapted from his “top ten” list, are some of the factors that strongly affect the success of passive investors. While financial professionals can help with all of these strategies, investors going it alone can also benefit from paying attention to them.

Link: http://rpseawright.wordpress.com/2013/06/04/financial-advice-a-top-ten-list/

Top Ten List

1. What’s the point?

A successful investment strategy starts with establishing clear, objective, and realistic goals. Most people bypass this step, thinking it is unrelated to their investment selection. Yet very few people on their deathbeds focus on how great it was to get a 7% annual return on their investments. Drilling down to what is really important in your life is no simple task, but it is essential. Creating a life worth living means using portfolio returns to support your dreams and desires! Knowing where you are going and why is the first step to establishing a successful portfolio.

2. A written investment plan.

Yes, you need your investment strategy in writing. This both insures that you have one and helps you clarify it. I find that writing things down often helps me find gaps and inconsistencies in what I thought was a complete and rational plan.

A written investment plan should state:

a. Your investment philosophy. Are you a passive or active investor, or both?

b. Your goals and objectives for your funds. This answers the question, “How and when will this money support my life?”

c. Guidelines and constraints you will adhere to in managing your money. What tenure do you want in a manager, what is your upper limit on expense ratios, how much flexibility will you give a manager, what quantifiable factors will take you out of a market or bring you back in?

A written plan will bring structure and discipline to your investment strategy, qualities most investors lack.

3. Manage your behavior.

We all have blind spots, biases, and delusions. How you behave in the face of market declines and advances will affect your long-term portfolio returns more than any other single factor. To make this even more challenging, your brain is naturally wired for investment failure. Identifying and reframing your money scripts can help you rewire your brain for success instead. Working with a financial coach or therapist can be invaluable to help you negotiate your own mind.

4. Financial planning.

Many people think financial planning is limited to investment advice. Yet it is much broader and deeper. Financial planning not only helps you build wealth, but helps you use it wisely to support the life you want.

Doctors

More:

Assessment

Six more keys to successful passive investing will be covered soon in Part II.

How to Succeed as an “Active-Passive” Investor [Part II]

Conclusion

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Empathy – the business of treating people [Video]

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A Cleveland Clinic Initiative

[By staff reporters]

If you haven’t seen this viral video yet, you’re in for tear-jerking treat.

A production of Cleveland Clinic highlighting the need to “understand” people in the medical setting. The direct implication is that such understanding goes beyond the medical setting, and can be transferred to all settings where people interact.

Watch “If We Could See Inside Others’ Hearts” here:

Delacroix[DELACROIX]

Assessment

This short film captures the essence of the “business” of treating people: empathy.

More: www.CertifiedMedicalPlanner.org

Conclusion

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Stakeholder Changes for Involvement in Medical Homes [2012-13]

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Update on the Patient Centered Medical Home Movement

By: www.MCOL.com

The medical home, also known as the patient-centered medical home (PCMH), is a team based health care delivery model led by a physician, PA, NP or ANP that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is “an approach to providing comprehensive primary care for children, youth and adults”.

The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).

MHs

Assessment

With a medical home, care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models.

Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-face patient encounter may help encourage coordination.

More:

Conclusion

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What All Doctors Need to Know About the Expiring Tax Provisions‏

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Avoid Losing Out on these Tax Breaks

By Bobby Whirley CPA and Kim Dore

Whirley & Associates, LLC

Certified Public Accountants

2500 Northwinds Parkway

Suite 190 – Alpharetta, GA 30009

770.932.1919 (ph) and 770.932.1192 (fax)

Dear ME-P Subscribers,

We wanted to let ME-P readers know about several important tax provisions affecting individuals and businesses that are slated to expire at the end of this year. While a budget conference is underway between the House and Senate, there is no way to know whether any agreement resulting from these negotiations will extend any expiring tax provisions. Because of this uncertainty, where possible, you should take action now to avoid losing out on tax breaks.

· Above-the-line deduction for certain higher education expenses – An above-the-line deduction is allowed for an individual taxpayer’s qualified tuition and related expenses. For 2013, the maximum deduction is $4,000 for taxpayers with modified AGI of not more than $65,000 ($130,000 for joint filers), and $2,000 for taxpayers with modified AGI that is equal to or more than the above amount but not more than $80,000 ($160,000 for joint filers). In general, the deduction is allowed for any tax year only to the extent the expenses are in connection with enrollment at an institution of higher education during that tax year. However, the deduction is allowed for qualified tuition and related expenses paid during a tax year if they are in connection with an academic term beginning during that tax year or during the first three months of the next tax year. The deduction does not apply for tax years beginning after 2013.

So, you may want to prepay in 2013 tuition due for an academic term beginning in Jan., Feb. or Mar. 2014 if that would increase your 2013 tax savings from the expiring deduction.

· Non-business energy credit –  Subject to limits (listed below), a taxpayer may be able to take a credit under Code Sec. 25C equal to the sum of: (1) 10% of the amount paid or incurred for qualified energy efficiency improvements, such as insulation material, exterior windows and skylights, and exterior doors, installed during 2013; and (2) any residential energy property costs, such as electric heat pumps, central air conditioners, natural gas, propane, or oil water heaters, or qualified natural gas, propane, and oil hot water boilers, paid or incurred in 2013. The expenses must be for property originally placed in service by the taxpayer and located in the U.S., and used as a principal residence at the time of installation. However, the credit is limited as follows:

·        A total combined credit limit of $500 for all tax years after 2005.

·        A combined credit limit of $200 for windows for all tax years after 2005.

·        A credit limit for residential energy property costs for 2013 of $50 for any advanced main air circulating fan; $150 for any qualified natural gas, propane, or oil furnace or hot water boiler; and $300 for any item of energy efficient building property.

So, if you have not made full use of the credit and are contemplating making such energy efficient improvements in the near future, you should do so before year-end to take advantage of the credit.

Tax

· Home mortgage debt forgiveness relief – For indebtedness discharged before Jan. 1, 2014, taxpayers generally may exclude up to $2 million of mortgage debt forgiveness on their principal residence. Gross income doesn’t include any discharge of qualified principal residence indebtedness. Generally, this relief allows the exclusion of income realized as a result of modification of the terms of the mortgage, foreclosure on a principal residence, or where the mortgage loan is not fully satisfied (e.g., in a short sale) and a lender cancels the unsatisfied debt. The basis of the taxpayer’s principal residence is reduced by the excluded amount, but not below zero.

So, if you are in the process of attempting to secure such relief from your lender you should take all possible steps to ensure that the discharge occurs before January 1st. of next year.

· Mortgage insurance premiums treated as deductible interest  – Mortgage insurance premiums paid or accrued by a taxpayer in connection with acquisition indebtedness with respect to the taxpayer’s qualified residence are treated as deductible qualified residence interest, subject to a phase-out based on the taxpayer’s AGI. However, this provision does not apply to premiums paid or accrued after Dec. 31, 2013 or properly allocable to any period after that date.

Thus, prepaying 2014 premiums this year won’t yield a deduction.

·  Above-the-line deduction for expenses of elementary and secondary school teachers. An eligible educator is allowed an above-the-line deduction, not in excess of $250, for otherwise allowable trade or business expenses paid or incurred by him in connection with books, supplies (other than nonathletic supplies for courses of instruction in health or physical education), computer equipment (including related software and services) and other equipment, and supplementary materials used by him in the classroom. The deduction is allowed only to the extent the expenses exceed the amount excludable for the tax year. This provision does not apply for tax years beginning after 2013.

So, a teacher who is not over the limit and who plans to purchase items in 2014 that would qualify for the deduction if it remained in effect should consider accelerating the purchases to 2013 to gain a deduction this year.

More:

Conclusion

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Video on Wall Street’s View on Prospects for the Health Care Industry

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Nashville Health Care Council

[By staff reporters]

The Nashville Health Care Council’s recent signature: “Wall Street’s View on Prospects for the Health Care Industry” panel discussion and video, offers timely insights and forecasts for Nashville’s $70 billion health care industry.

Medical tree

Video link: http://www.healthsharetv.com/content/wall-streets-view-prospects-health-care-industry

Assessment

The effects of the PP-ACA are still being revealed under the law of unintended consequences.

Conclusion

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Update on Estate and Probate Law

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INCREASING TRUST INCOME TAX EFFICIENCY AFTER ATRA WITH BETTER BYPASS TRUST OPTIONS [Ohio]

By Edwin P. Morrow III; JD LL.M, MBA CFP® RFC® CMP® [Hon]

Ed Morrow III JDDave, Ann and ME-P Readers,

Many doctors are flummoxed with whether they need any “AB” trust in light of the new tax laws.  

I’ve written quite a lot on this and have attached a short and a long version to review:

VIEW: Ohio Law

VIEW: Optimal Basis Increase Trust Sept 2013

You could delete the outdated ME-P sections on EGTTRA and replace them with some of this (although it may be too much for doctors and laypeople, so I’ve also toned-it-down similar to the shorter version above).

Assessment

Also, you should cover captive insurance companies if you have not already. Which physician/practice owners should consider it?  How do you start? How do you choose a captive manager and attorney?  What should you watch out for?  I could do that too, I think I have some material.

More on Alternative Insurance Companies:

More on Asset Protection:

ABOUT THE AUTHOR:

Mr. Edwin P. Morrow III, a friend of the Medical Executive-Post, is a Wealth Specialist and Manager, Wealth Strategies Communications Ohio State Bar Association Certified Specialist, Estate Planning, Probate and Trust Law Key Private Bank Wealth Advisory Services. 10 W. Second St., 27th Floor Dayton, OH 45402. He is an ME-P “thought leader”.

This essay is based on presentation by the author at the Wealth Management Conference at Columbus on June 13, 2013.

Conclusion

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Healthcare News TV Videos

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Announcing More New Videos:

Advocacy

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